Lipid Reducers
PHARM-13 Statement of Medical Necessity for Quantity Limits Override.
| Lipid Reducers |
Drugs |
Quantity Limits |
Advicor (Niacin - Lovastatin) 500mg - 20mg, 750mg - 20 mg, 1000mg - 20mg and 1000mg - 40mg Tablets |
30 Tablets per 30 Days |
Questran (Cholestyramine - Sucrose) 4gm Packets |
60 Packets per 30 Days |
Questran Light (Cholestyramine - Aspartame) 4gm Packets |
60 Packets per 30 Days |
Simcor (Niacin - Simvastatin) 500mg - 20mg, 750mg - 20mg and 1000mg - 20mg Tablets |
30 Tablets per 30 Days |
Last Modified on
Nov 17, 2020
