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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
KADIAN® 05/15/09 The limits are 2 capsules per day.
KALETRA 07/01/12 The limits are 2 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.