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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
OCUDOX® KIT 04/01/13 Ocudox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
OFORTA™ 12/22/09 Prior authorization for medical necessity is required.
OMEPRAZOLE 01/01/00 The limits are 1 capsule per day.
OMEPRAZOLE-SODIUM BICARBONATE 07/01/10 Omeprazole-sodium bicarbonate may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 tablet per day.
OMNARIS™ 08/06/08 The limits are 1 box per 30 days.
OMNITROPE® 10/01/11 Prior authorization for medical necessity is required.
ONGLYZA™ 08/27/09 The limits are 1 tablet per day.
ONSOLIS™ 09/18/09 Prior authorization for medical necessity is required. The limits are 4 tablets per day.
OPANA ER® 02/15/07 The limits are 2 tablets per day.
OPANA® 01/01/13 The limits are 6 tablets per day.
ORACEA® 04/01/13 Oracea may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
ORAMORPH® SR 05/15/09 The limits are 3 tablets per day.
ORAXYL® 04/01/13 Oraxyl may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
ORBIVAN 04/01/13 The limits are 6 capsules per day.
ORBIVAN CF 04/01/13 The limits are 6 tablets per day.

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