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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
ZAMICET" 05/15/09 The limits are 90mL per day.
ZECUITY 07/01/13 The limits are 12 transdermal systems per 30 days.
ZEGERID® 08/01/06 Zegerid may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 1 capsule or packet per day.
ZELBORAF® 01/01/12 Prior authorization for medical necessity is required. The limits are 8 tablets per day.
ZERIT 07/01/12 The limits are 2 capsules or 80 mL per day.
ZETONNA 07/01/12 The limits are 1 bottle per 30 days.
ZIAGEN 07/01/12 The limits are 2 tablets or 32 mL per day.
ZIANA® 07/01/07 Prior authorization for medical necessity may be required.
ZIOPTAN 07/01/12 The limits are 1 single-use container per day.
ZOCOR® 01/01/11 Zocor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin).
ZOFRAN® 02/01/05 The limits are 21 tablets per 30 days for Zofran 4mg and 8mg, and 1 tablet per 30 days for Zofran 24mg.
ZOFRAN® ODT 02/01/05 The limits are 21 tablets per 30 days.
ZOHYDRO ER 04/01/14 The limits are 2 capsules per day.
ZOLINZA® 01/01/12 Prior authorization for medical necessity is required. The limits are 4 capsules per day.
ZOLPIMIST" 05/15/09 The limits are 1 container per month.

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