**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 28 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. Predetermination for medical necessity is available when physician-administered. |

FIRST-LANSOPRAZOLE | 07/01/12 | FIRST-Lansoprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 10 mL per day. |

FIRST-OMEPRAZOLE | 07/01/12 | FIRST-Omeprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 20 mL per day. |

FIRST-TESTOSTERONE | 04/01/12 | The limits are 60 grams per 30 days. |