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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
TAFINLAR® 01/01/14 Prior authorization for medical necessity is required. The limits are 4 capsules per day.
TALACEN 04/01/12 The limits are 180 tablets per 30 days.
TAMIFLU® 02/01/05 The limits are 20 capsules per 30 days for Tamiflu 30mg, 10 capsules per 30 days for Tamiflu 35mg and 75mg, and 180 mL per 30 days for Tamiflu 6mg/mL oral suspension.
TARCEVA® 03/14/07 Prior authorization for medical necessity is required. The limits are 1 tablet per day, except 25mg tablets with a limit of 2 tablets per day.
TARGRETIN® 01/01/12 Prior authorization for medical necessity is required.
TASIGNA® 04/01/11 Prior authorization for medical necessity is required. The limits are 4 capsules per day.
TAZAROTENE 04/01/01 Prior authorization for medical necessity may be required.
TAZORAC® 04/01/01 Prior authorization for medical necessity may be required.
TECFIDERA™ 05/01/13 The limits are 2 capsules per day and 1 starter kit per 30 days.
TEKAMLO® 01/01/11 Tekamlo may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEKTURNA HCT® 01/01/11 Tekturna HCT may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEKTURNA® 01/01/11 Tekturna may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).
TEMODAR® 01/01/12 Prior authorization for medical necessity is required.
TESTIM® 06/15/04 The limits are 10 grams per day.
TESTRED® 04/01/12 Prior authorization for medical necessity is required.

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