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Product Name  Implementation Date  Guideline 

JAKAFI™  04/01/12  Prior authorization for medical necessity is required. The limits are 2 tablets per day. 
JANUMET®  05/01/07  The limits are 2 tablets per day. 
JANUMET® XR  07/01/12  The limits are 1 tablet per day, except 50 mg/1000 mg tablets which have a limit of 2 tablets per day. 
JANUVIA®  11/01/06  The limits are 1 tablet per day. 
JARDIANCE®  10/01/14  The limits are 1 tablet per day. 
JENTADUETO®  07/01/12  The limits are 2 tablets per day. 
JUVISYNC  04/01/12  The limits are 30 tablets per 30 days, except for the 5010 mg and 5020 mg strengths with a limit of 60 tablets per 30 days. 
JUXTAPID  07/01/13  Prior authorization for medical necessity is required. The limits are 1 capsule per day. 
