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PHARM-13 Statement of Medical Necessity for Quantity Limits Override.
Drugs
Quantity Limits
Amrix (Cyclobenzaprine HCL) 15mg and 30mg SR Capsules
Fexmid (Cyclobenzaprine HCL) 7.5mg Tablets
Soma (Carisoprodol) 250mg and 350mg Tablets
Soma Compound (Carisoprodol - Aspirin) 200mg - 325mg Tablets