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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
NARCAN NASAL SPRAY 04/01/16 The limits are 1 package (2 nasal sprays) per 365 days.
NASACORT AQ® 04/01/04 The limits are 1 box per 30 days.
NASAREL® 08/06/08 The limits are 3 boxes per 30 days.
NASONEX® 02/22/05 The limits are 1 box – 17 g per 30 days.
NATESTO® 07/01/15 May be subject to step therapy requirements. Patients must have trial and failure of Androderm or Androgel. The limits are 180 pumps per 30 days.
NATPARA® 10/01/15 Prior Authorization for medical necessity is required. The limits are 14 packages of 2 cartridges per 28 days.
NESINA 04/01/13 The limits are 1 tablet per day.
NEULASTA® 04/01/15 Prior authorization for medical necessity is required when physician-administered.
NEUPOGEN® 04/01/15 Prior authorization for medical necessity is required when physician-administered.
NEVIRAPINE 07/01/12 The limits are 40 mL per day.
NEXAVAR® 01/01/06 Prior authorization for medical necessity is required. The limits are 4 tablets per day.
NEXIUM® 01/01/00 Nexium may be subject to step therapy requirements. Patients must have trial and failure of generic esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 capsule or packet for oral suspension per day.
NICAZELDOXY® KIT 01/01/14 Nicazeldoxy may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND generic immediate release minocycline.
NINLARO® 04/01/16 Prior authorization for medical necessity is required. The quantity limites are 3 capsules per 28 days.
NORCO® 09/01/03 The limits are 12 for the 5 mg tablets and 6 for the 7.5 and 10 mg tablets per day. Patients should not take more than a total of 4 grams of acetaminophen per day (3 grams per day if you have liver disease).

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