OPIATE DEPENDENCE TREATMENTS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	00228315603 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	00378092393 MYLAN	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	42858050103 RHODES PHARMACE	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	62756045983 SUN PHARMACEUTI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	50383092493 HI-TECH/AKORN C	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 8 MG TABLET SL buprenorphine HCl	00904715504 MAJOR PHARMACEU	Yes	No	Medicaid CHIP CSHCN
BUPRENORPHINE 8 MG TABLET SL buprenorphine HCl	60687049211 AHP	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 8 MG TABLET SL buprenorphine HCl	60687049221 AHP	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 8 MG TABLET SL buprenorphine HCl	00054017713 WEST-WARD/HIKMA	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 8 MG TABLET SL buprenorphine HCl	00228315303 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN HTWPlus