**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-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. |

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. |

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. |