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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
IBUDONE" 05/15/09 The limits are 5 tablets per day.
ICLUSIG" 04/01/13 Prior authorization for medical necessity is required. The limits are 2 tablets per day of the 15 mg tablets and 1 tablet per day of the 45 mg tablets.
ILARIS® 08/10/09 Prior authorization for medical necessity is required. Patients must be at least 4 years of age. The limits are one 180 mg vial every 8 weeks.
IMBRUVICA® 01/01/14 Prior authorization for medical necessity is required. The limits are 4 capsules per day.
IMITREX® 11/01/05 The limits are 18 tablets, 12 nasal spray units, 10 vials, or 6 kits per 30 days.
INCIVEK" 10/01/11 Prior authorization for medical necessity is required.
INCRELEX® 01/01/06 Prior authorization for medical necessity is required.
INLYTA® 07/01/12 Prior authorization for medical necessity is required. The limits are 6 tablets per day of the 1 mg tablets and 4 tablets per day of the 5 mg tablets.
INTELENCE 07/01/12 The limits are 2 tablets per day, except 25 mg tablets with a limit of 4 tablets per day.
INTERMEZZO" 07/01/12 The limits are 1 tablet per day.
INVIRASE 07/01/12 The limits are 10 capsules or 4 tablets per day.
INVOKANA 04/01/14 The limits are 1 tablet per day.
ISENTRESS 07/01/12 The limits are 6 tablets per day for 25 mg, 4 tablets per day for 100 mg, and 2 tablets per day for 400 mg strengths.