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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
ELIQUIS 07/01/13 The limits are 2 tablets per day for Eliquis 2.5mg and 4 tablets per day for Eliqus 5 mg.
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® 09/01/04 The limits are 12 tablets for the 2.5 mg and 5 mg oxycodone tablets, 8 tablets for the 7.5 mg tablets, and 6 tablets for the 10 mg tablets per day.
ENTRESTO® 07/08/15 Prior authorization for medical necessity may be required. The quantity limits are 2 tablets per day.
ENTYVIO® 01/01/15 Prior authorization for medical necessity is required.
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.
ERBITUX® 01/01/15 Prior authorization for medical necessity is required.
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.

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