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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
EFFEXOR XR® 07/01/05 The limits are 1 capsule per day, except Effexor XR 75mg which has a limit of 3 capsules per day.
ELIQUIS 07/01/13 The limits are 2 tablets per day.
EMBEDA" 09/09/09 The limits are 2 capsules per day.
EMEND® 11/12/08 The limits are 4 capsules per 30 days for Emend 80mg, 2 capsules per 30 days for Emend 125mg, and 2 packs (6 capsules) per 30 days for Emend 125mg/80mg packs.
EMTRIVA 07/01/12 The limits are 1 capsule or 24 mL per day.
ENBREL® 05/17/99 Enbrel may be subject to step therapy requirements. Patients must have trial and failure of a first-line DMARD. The limits are 8 doses of Enbrel 25mg or 4 doses of Enbrel 50mg per 28 days.
ENDOCET® 01/01/00 The limits for are 12 tablets per day for Endocet 5-325mg , 8 tablets per day for 7.5-325mg and 7.5-500mg, and 6 tablets per day for 10-325mg and 10-650mg.
EPIDUO® 01/01/11 Prior authorization for medical necessity may be required.
EPIVIR 07/01/12 The limits are 1 tablet or 32 mL per day.
EPZICOM 07/01/12 The limits are 1 tablet per day.
ERIVEDGE" 07/01/12 Prior authorization for medical necessity is required. The limits are 1 capsule per day.
ESGIC 04/01/13 The limits are 6 tablets or capsules per day.
ESGIC PLUS 04/01/13 The limits are 6 tablets or capsules per day.
ESOMEPRAZOLE STRONTIUM 01/01/14 Esomeprazole strontium 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 per day.
EXALGO® 04/14/10 The limits are 1 tablet per day.

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