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

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 | |

ENTRESTO® | 07/08/15 | Prior authorization for medical necessity may be required. The quantity limits are 2 tablets per day. |

EPIDUO® | 01/01/11 | Prior authorization for medical necessity may be required. |

EPIVIR | 07/01/12 | The limits are 2 tablets for Epivir 150 mg, 1 tablet for Epivir 300 mg or 960 ml/month for Epivir solution. |

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. |

ESBRIET® | 10/20/14 | Prior authorization for medical necessity is required. The limits are 9 capsules 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. |

EVOTAZ® | 04/01/15 | The limits are 1 tablet per day. |

EVZIO® | 02/01/15 | The limits are 1 package (2 auto-injections) per 365 days. |

EXALGO® | 04/14/10 | The limits are 1 tablet per day. |