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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.
TAGRISSO 11/25/15 Prior authorization for medical necessity is required. Limits are 30 tablets per 30 days.
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.
TANZEUM® 10/01/14 Tanzeum may be subject to step therapy requirements. Patients must have trial and failure of one or more of the following antidiabetic agents: metformin, sulfonylurea, combinations of metformin or sulfonylureas, or basal insulin (Lantus or Levemir). The limits are 4 vials per 28 days.
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.
TARGADOX® 06/21/15 Targadox may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline AND immediate release minocycline.
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.
TECHNIVIE® 08/14/15 Prior authorization for medical necessity may be required. Quantity limits may apply.
TEKAMLO® 01/01/11 Tekamlo may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.
TEKTURNA HCT® 01/01/11 Tekturna HCT may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE inhibitor or generic ARB.

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