All
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Product Name | Implementation Date | Guideline |
---|---|---|
FABIOR | 07/01/13 | Prior authorization for medical necessity may be required. |
FARXIGA® | 04/01/14 | The limits are 1 tablet per day. |
FARYDAK® | 07/01/15 | The limits are 6 capsules per 21 days. |
FENTANYL CITRATE LOZENGE | 06/23/03 | Prior authorization for medical necessity is required. The limits are 4 lozenges per day. Patients must be at least 16 years of age. |
FENTANYL TD® | 03/03/15 | The limits are 15 patches per 30 days. |
FENTORA® | 09/01/06 | Prior authorization for medical necessity is required. Patients must have trial and failure of generic product. The limits are 4 tablets per day. |
FETZIMA® | 01/01/14 | The limits are 1 capsule per day or 1 titration pack per 180 days. |
FIORICET | 04/01/13 | The limits are 6 tablets per day. |
FIORICET WITH CODEINE | 04/01/13 | The limits are 6 tablets per day. |
FIORINAL | 04/01/13 | The limits are 6 capsules per day. |
FIORINAL WITH CODEINE | 04/01/13 | The limits are 6 capsules per day. |
FIRAZYR® | 04/01/12 | Prior authorization for medical necessity is required when self-administered or physician-administered. |
FIRST-TESTOSTERONE | 04/01/12 | The limits are 60 grams per 30 days. |
FIRST-TESTOSTERONE MC | 04/01/12 | The limits are 60 grams per 30 days. |
FLEBOGAMMA® | Prior authorization for medical necessity is required. |
1 2 |