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

FENTORA® | 09/01/06 | Prior authorization for medical necessity is required. The limits are 4 tablets per day. |

FETZIMA® | 01/01/14 | The limits are 1 capsule per day or 1 titration pack per 28 days. |

FIORICET | 04/01/13 | The limits are 6 tablets per day. |

FIORICET WITH CODEINE | 04/01/13 | The limits are 6 tablets per day. |

FIORINAL | 04/01/13 | The limits are 6 capsules per day. |

FIORINAL WITH CODEINE | 04/01/13 | The limits are 6 capsules per day. |

FIRAZYR® | 04/01/12 | Prior authorization for medical necessity is required. The limits are 3 syringes per prescription. |

FIRST-LANSOPRAZOLE | 07/01/12 | FIRST-Lansoprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 10 mL per day. |

FIRST-OMEPRAZOLE | 07/01/12 | FIRST-Omeprazole may be subject to step therapy requirements. Patients must have trial and failure of generic lansoprazole, omeprazole, pantoprazole, or rabeprazole. The limits are 20 mL per day. |

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. |