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 50-10 mg and 50-20 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. |