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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
BETHKIS® 01/01/14 Prior authorization for medical necessity may be required. Must not be used concurrently with inhaled tobramycin or Cayston.
BINOSTO® 01/01/13 The limits are 4 tablets per 28 days.
BIO-T-GEL® 10/01/12 The limits are 2 packets per day.
BIVIGAM™ 01/01/15 Prior authorization for medical necessity is required.
BONIVA® 06/01/05 The limits are 1 tablet per 30 days for Boniva 150mg.
BOSULIF® 11/15/12 Prior authorization for medical necessity is required. The limits are 1 tablet per day.
BOTOX® 01/01/15 Prior authorization for medical necessity is required.
BREO ELLIPTA® 01/01/14 The limits are 1 inhaler per month.
BUNAVIL® 01/01/15 Prior authorization for medical necessity is required. The 2.1mg film has a quantity limit of 3 per day. The 4.2mg and 6.3mg film has a limit of 2 per day.
BUPHENYL® 07/01/13 Prior authorization for medical necessity is required.
BUPRENORPHINE 04/01/16 Prior authorization for medical necessity is required. The limits are 5 tablets per 90 days.
BUTALBITAL COMPOUND 04/01/13 The limits are 6 tablets per day.
BUTALBITAL/ACETAMINOPHEN 04/01/13 The limits are 6 tablets per day.
BUTRANS® 04/01/11 The limits are 4 transdermal systems per 30 days.
BYDUREON® 04/01/12 Bydureon may be subject to step therapy requirements. Patients must have trial and failure of one or more of the following antidiabetic agents: metformin, sulfonylurea, combinations of metformin or sulfonylureas, or basal insulin (Lantus or Levemir). The limits are 4 vials or pens per 28 days.

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