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. |