Product Name |
Implementation Date |
Guideline |
KADIAN®
| 05/15/09 |
The limits are 2 capsules per day. |
KALETRA
| 07/01/12 |
The limits are 10 tablets per day for 100 mg/25 mg, 4 tablets per day for 200 mg/50 mg, and 11 mL per day for 80 mg/20 mg per mL oral solution. |
KALYDECO
| 07/01/12 |
Prior authorization for medical necessity is required. The limits are 2 tablets per day. |
KAZANO
| 04/01/13 |
The limits are 2 tablets per day. |
KHEDEZLA®
| 01/01/14 |
The limits are 30 tablets per 30 days. |
KINERET®
| 07/17/02 |
Kineret may be subject to step therapy requirements. Patients must have trial and failure of Humira AND Enbrel. The limits are 1 syringe per day. |
KOMBIGLYZE XR
| 04/01/11 |
The limits are 1 tablet per day, except Kombiglyze XR 2.5-1000mg which has a limit of 2 tablets per day. |
KORLYM
| 10/01/12 |
Prior authorization for medical necessity is required. The limits are 2 tablets per day. |
KYNAMRO
| 07/01/13 |
Prior authorization for medical necessity is required. |
KYTRIL®
| 12/03/01 |
The limits are 14 tablets per 30 days. |