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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
MAGNACET" 09/01/04 The limits are 10 tablets per day for Magnacet 5/400mg. The limits are 8 tablets per day for Magnacet 7.5/400mg and 6 tablets per day for Magnacet 10/400mg.
MATULANE® 01/01/12 Prior authorization for medical necessity is required.
MAXAIR 04/01/12 The limits are 1 inhaler per 30 days.
MAXALT® 11/01/05 The limits are 18 tablets per 30 days.
MAXIDONE" 09/01/03 The limits are 5 tablets per day.
MEKINIST® 01/01/14 Prior authorization for medical necessity is required. The limits are 3 tablets per day for 0.5 mg strength and 1 tablet per for all other strengths.
METADATE CD® 01/01/05 The limits are 2 capsules per day, except Metadate CD 60mg which has a limit of 1 capsule per day.
METAGLIP" 08/06/08 The limits are 4 tablets per day, except Metaglip 2.5/250mg which has a limit of 8 tablets per day.
METHADONE 01/01/13 The limits for the 5 mg/5 mL solution is 30 mL per day and the 10 mg/5 mL solution is 15 mL per day.
METHADOSE 01/01/13 The limits are 3 tablets per day or 3 mL of the 10 mg/mL concentrated solution per day.
METHITEST® 04/01/12 Prior authorization for medical necessity is required.
MEVACOR® 01/01/11 Mevacor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).
MICARDIS HCT® 01/01/11 Micardis HCT may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.
MICARDIS® 01/01/11 Micardis may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.
MINOCIN® 04/01/13 Minocin may be subject to step therapy requirements. Patients must have a trial and failure of generic immediate release minocycline.

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