**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 |
---|---|---|

CRESTOR® | 01/01/11 | Crestor may be subject to step therapy requirements. Patients must have trial and failure of generic statin (lovastatin, pravastatin, simvastatin). |

CRIXIVAN | 07/01/12 | The limits are 9 capsules per day for 200 mg, and 6 capsules per day for 400 mg strengths. |

CYCLOSET | 04/01/12 | The limits are 180 tablets per 30 days. |

CYMBALTA® | 09/01/04 | The limits are 2 capsules per day, except Cymbalta 60mg with a limit of 1 capsule per day. |

DANAZOL | 04/01/12 | Prior authorization for medical necessity is required. |

DAYTRANA® | 06/12/06 | The limits are 1 patch per day. |

DEMEROL | 01/01/13 | The limits are 8 tablets per day for 50 mg and 100 mg tablets. Demerol 50 mg/5 mL solution has a limit of 80 mL/day. |

DESVENLAFAXINE SR 24HR | 07/01/13 | The limits are 1 tablet per day. |

DEXILANT™ | 07/01/10 | Dexilant 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. |

DIABENESE | 04/01/12 | The limits are 60 tablets per 30 days for 100mg and 90 tablets per 30 days for 250mg. |

DIABETA | 04/01/12 | The limits are 30 tablets per 30 days for 1.25mg and 2.5mg tablets, and 120 tablets per 30 days for 5mg tablets. |

DIDANOSINE | 07/01/12 | The limits are 1 capsule per day. |

DIFFERIN® | 04/01/01 | Prior authorization for medical necessity may be required. |

DILAUDID | 01/01/13 | The limits are 6 tablets per day or 48 mL/day for the Dilaudid 1 mg/mL solution. |

DIOVAN HCT® | 01/01/11 | Diovan 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). |