Product Name |
Implementation Date |
Guideline |
EDARBI™
| 04/01/11 |
Edarbi may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT). |
EDARBYCLOR™
| 07/01/12 |
Edarbyclor may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT). |
EDEX®
| 07/01/10 |
Prior authorization for medical necessity may be required. Patients must be at least 18 years of age. |
EDLUAR™
| 07/06/09 |
The limits are 1 tablet per day. |
EDURANT
| 07/01/12 |
The limits are 1 tablet per day. |
EFFEXOR XR®
| 07/01/05 |
The limits are 1 capsule per day, except Effexor XR 75mg which has a limit of 3 capsules per day. |
ELIQUIS
| 07/01/13 |
The limits are 2 tablets per day for Eliquis 2.5mg and 4 tablets per day for Eliqus 5 mg. |
EMBEDA™
| 09/09/09 |
The limits are 2 capsules per day. |
EMEND®
| 11/12/08 |
The limits are 4 capsules per 30 days for Emend 80mg, 2 capsules per 30 days for Emend 125mg, and 2 packs (6 capsules) per 30 days for Emend 125mg/80mg packs. |
EMTRIVA
| 07/01/12 |
The limits are 1 capsule or 24 mL per day. |
ENBREL®
| 05/17/99 |
Enbrel may be subject to step therapy requirements. Patients must have trial and failure of a first-line DMARD. The limits are 8 doses of Enbrel 25mg or 4 doses of Enbrel 50mg per 28 days. |
ENDOCET®
| 01/01/00 |
The limits for are 12 tablets per day for Endocet 5-325mg , 8 tablets per day for 7.5-325mg and 7.5-500mg, and 6 tablets per day for 10-325mg and 10-650mg. |
EPIDUO®
| 01/01/11 |
Prior authorization for medical necessity may be required. |
EPIVIR
| 07/01/12 |
The limits are 2 tablets for Epivir 150 mg, 1 tablet for Epivir 300 mg or 32 mL per day for Epivir solution. |
EPZICOM
| 07/01/12 |
The limits are 1 tablet per day. |