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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
FIRST-TESTOSTERONE 04/01/12 The limits are 60 grams per 30 days.
FIRST-TESTOSTERONE MC 04/01/12 The limits are 60 grams per 30 days.
FLECTOR® PATCH 08/06/08 Prior authorization for medical necessity is required. The limits are 2 patches per day. Patients must be at least 18 years of age.
FLONASE® 04/01/04 The limits are 1 box per 30 days.
FLOVENT DISKUS® 04/01/05 The limits are 2 blisters per day for Flovent 50mcg and 100mcg. The limits are 8 blisters per day for Flovent 250mcg.
FLOVENT HFA® 04/01/05 The limits are 1 inhaler per 30 days for 44mcg and 110mcg, and 2 inhalers per 30 days for 220mcg.
FLUNISOLIDE NASAL SPRAY 01/01/12 The limits are 3 bottles (75mL) per 30 days.
FOCALIN® XR 07/01/05 The limits are 2 capsules per day except for Focalin XR 25mg, 30mg, 35mg, and 40mg which have a limit of 1 capsule per day.
FORADIL® AEROLIZER® 08/06/08 The limits are 2 blisters per day.
FORFIVO XL 07/01/12 The limits are 1 tablet per day.
FORTAMET® 05/15/09 The limits are 3tablets per day for Fortamet 500mg and 2 tablets per day for Fortamet 1000mg.
FORTEO® 08/06/08 Prior authorization for medical necessity is required.
FORTESTA 07/01/11 The limits are 120 grams (2 bottles) per 30 days.
FOSAMAX PLUS D® 04/25/05 The limits are 4 tablets per 30 days.
FOSAMAX® 01/01/00 The limits are 1 tablet per day for Fosamax 5mg, 10mg, and 40mg tablets. The limits are 4 tablets per 30 days for Fosamax 35 mg and 70 mg tablets.

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