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