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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
DIOVAN® 01/01/11 Diovan may be subject to step therapy requirements. Patients must have trial and failure of a generic ACE Inhibitor or generic ARB.
DOLGIC PLUS 04/01/13 The limits are 5 tablets per day.
DOLOPHINE 01/01/13 The limits are 3 tablets per day.
DORYX® 11/14/07 Doryx may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
DOXYCYCLINE 04/01/13 Doxycycline may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release doxycycline.
DUETACT® 07/01/10 The limits are 1 tablet per day.
DULERA® 01/01/11 The limits are 1 inhaler per 30 days.
DURAGESIC® 09/01/04 The limits are 15 patches per 30 days.
DYMISTA® 10/01/12 The limits are 1 bottle (23 grams) per 30 days.
DYNACIN® 04/01/13 Dynacin may be subject to step therapy requirements. Patients must have trial and failure of generic immediate release minocycline.
EDARBI" 04/01/11 Edarbi 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).
EDARBYCLOR" 07/01/12 Edarbyclor 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).
EDEX® 07/01/10 Prior authorization for medical necessity may be required. Patients must be at least 18 years of age.
EDLUAR" 07/06/09 The limits are 1 tablet per day.
EDURANT 07/01/12 The limits are 1 tablet per day.

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