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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.
FENTANYL CITRATE LOLLIPOP 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.
FENTORA® 09/01/06 Prior authorization for medical necessity is required. 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. The limits are 3 syringes per prescription.
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.
FIRST-TESTOSTERONE MC 04/01/12 The limits are 60 grams per 30 days.
FLECTOR® PATCH 08/06/08 Prior authorization for medical necessity is required. The limits are 2 patches per day. Patients must be at least 18 years of age.

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