Displaying 51 - 100 of 513 records found.

Items in this class
Brand Name/Generic Name NDC code Clinical Prior Auth Required PDL Prior Auth Required
BUTORPHANOL 10 MG/ML SPRAY
butorphanol tartrate
00378963943 Yes Yes
CAPITAL WITH CODEINE SUSP
acetaminophen with codeine
00187000301 Yes Yes
CARISOPRODOL-ASPIRIN-CODEIN TB
carisoprodol/aspirin/codeine
64980017601 Yes Yes
CODEINE SULFATE 30 MG TABLET
codeine sulfate
00054024425 Yes Yes
CODEINE SULFATE 60 MG TABLET
codeine sulfate
00054024525 Yes Yes
DILAUDID 2 MG TABLET
hydromorphone HCl
42858012201 Yes Yes
DILAUDID 4 MG TABLET
hydromorphone HCl
42858023450 Yes Yes
DILAUDID 4 MG TABLET
hydromorphone HCl
42858023401 Yes Yes
DILAUDID 5 MG/5 ML ORAL LIQUID
hydromorphone HCl
42858041616 Yes Yes
DILAUDID 8 MG TABLET
hydromorphone HCl
42858033801 Yes Yes
ENDOCET 10-325 MG TABLET
oxycodone HCl/acetaminophen
60951071270 Yes No
ENDOCET 2.5-325 MG TABLET
oxycodone HCl/acetaminophen
60951070170 Yes No
ENDOCET 5-325 TABLET
oxycodone HCl/acetaminophen
60951060270 Yes No
ENDOCET 5-325 TABLET
oxycodone HCl/acetaminophen
60951060285 Yes No
ENDOCET 7.5-325 MG TABLET
oxycodone HCl/acetaminophen
60951070070 Yes No
FENTANYL CIT OTFC 1,200 MCG
fentanyl citrate
00093786965 Yes Yes
FENTANYL CIT OTFC 1,200 MCG
fentanyl citrate
00406921230 Yes Yes
FENTANYL CIT OTFC 1,600 MCG
fentanyl citrate
00093787065 Yes Yes
FENTANYL CIT OTFC 1,600 MCG
fentanyl citrate
00406921630 Yes Yes
FENTANYL CITRATE OTFC 200 MCG
fentanyl citrate
00093786565 Yes Yes
FENTANYL CITRATE OTFC 200 MCG
fentanyl citrate
00406920230 Yes Yes
FENTANYL CITRATE OTFC 400 MCG
fentanyl citrate
00093786665 Yes Yes
FENTANYL CITRATE OTFC 400 MCG
fentanyl citrate
00406920430 Yes Yes
FENTANYL CITRATE OTFC 600 MCG
fentanyl citrate
00093786765 Yes Yes
FENTANYL CITRATE OTFC 600 MCG
fentanyl citrate
00406920630 Yes Yes
FENTANYL CITRATE OTFC 800 MCG
fentanyl citrate
00093786865 Yes Yes
FENTANYL CITRATE OTFC 800 MCG
fentanyl citrate
00406920830 Yes Yes
FENTORA 100 MCG BUCCAL TABLET
fentanyl citrate
63459054128 Yes Yes
FENTORA 200 MCG BUCCAL TABLET
fentanyl citrate
63459054228 Yes Yes
FENTORA 400 MCG BUCCAL TABLET
fentanyl citrate
63459054428 Yes Yes
FENTORA 600 MCG BUCCAL TABLET
fentanyl citrate
63459054628 Yes Yes
FENTORA 800 MCG BUCCAL TABLET
fentanyl citrate
63459054828 Yes Yes
FIORINAL-COD 30-50-325-40 CAP
codeine/butalbital/ASA/caffein
52544095601 Yes Yes
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
27808011601 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
27808011602 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
43386035301 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
43386035305 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
00406037801 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
00406037805 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
65162069610 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
64376064301 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
65162069650 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
64376064305 Yes No
HYDROCODONE-ACETAMIN 10-300 MG
hydrocodone/acetaminophen
00591217601 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
00591261201 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
00591261205 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
00406012501 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
00406012505 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
00406012510 Yes No
HYDROCODONE-ACETAMIN 10-325 MG
hydrocodone/acetaminophen
53746011001 Yes No