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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
H.P. ACTHAR GEL® 04/01/12 Prior authorization for medical necessity is required.
HEXALEN® 01/01/12 Prior authorization for medical necessity is required.
HIZENTRA™ 04/14/10 Prior authorization for medical necessity is required.
HORIZANT® 01/01/12 The limits are 60 tablets per 30 days.
HUMATROPE® 10/01/11 Prior authorization for medical necessity is required. Use of the preferred growth hormone, Omnitrope, may be required.
HUMIRA® 01/17/03 Humira may be subject to step therapy requirements. Patients must have trial and failure of a first-line DMARD. The limits are 2 doses per 28 days. One starter kit for Crohn's disease or Psoriasis will be covered per 180 days.
HYCAMTIN® 01/01/12 Prior authorization for medical necessity is required.
HYCET™ 05/15/09 The limits are 120mL per day.
HYDROCODONE/ACETAMINOPHEN 10/01/12 The limits are 12 tablets per day for 2.5mg-325mg tablets.
HYZAAR® 01/01/11 Hyzaar 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).