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Product Name Implementation Date Guideline
CIMZIA® 06/23/09 Cimzia may be subject to step therapy requirements. Patients must have trial and failure of Humira AND Enbrel. The limits are two 200 mg vials or syringes per 28 days. One starter kit (containing 6 syringes) is available per 180 days.
COCET PLUS® 01/01/11 The limits are 6 tablets per day.
COCET® 04/01/13 The limits are 6 tablets per day.
CODEINE 01/01/13 The limits are 180 tablets per 30 days.
COMBIVENT 04/01/12 The limits are 2 inhalers per 30 days.
COMBIVENT RESPIMAT 07/01/12 The limits are 2 inhalers per 30 days.
COMBIVIR 07/01/12 The limits are 2 tablets per day.
COMBUNOX® 05/01/05 The limits are 120 tablets per 30 days.
COMETRIQ™ 04/01/13 Prior authorization for medical necessity is required. The limits are 1 kit/28 days.
COMPLERA 07/01/12 The limits are 1 tablet per day.
COMPOUNDS 01/01/00 Prior authorization for medical necessity may be required.
CONCERTA® 11/01/02 The limits are 2 tablets per day.
CONZIP® 01/01/12 The limits are 30 capsules per 30 days.
COPAXONE® 10/01/12 The limits are 1 carton of 30 syringes per 30 days.
COZAAR® 01/01/11 Cozaar may be subject to step therapy requirements. Patients must have trial and failure of both of the following: 1) generic ACE inhibitor or generic ARB, AND 2) preferred brand ARB (Diovan, Exforge/HCT, Micardis/HCT).

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