ANALGESICS: NARCOTICS LONG | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BUTRANS 10 MCG/HR PATCH buprenorphine	59011075104 PURDUE PHARMA L	Yes	No	Medicaid CHIP CSHCN
BUTRANS 15 MCG/HR PATCH buprenorphine	59011075804 PURDUE PHARMA L	Yes	No	Medicaid CHIP CSHCN
BUTRANS 20 MCG/HR PATCH buprenorphine	59011075204 PURDUE PHARMA L	Yes	No	Medicaid CHIP CSHCN
BUTRANS 5 MCG/HR PATCH buprenorphine	59011075004 PURDUE PHARMA L	Yes	No	Medicaid CHIP CSHCN
BUTRANS 7.5 MCG/HR PATCH buprenorphine	59011075704 PURDUE PHARMA L	Yes	No	Medicaid CHIP CSHCN
FENTANYL 100 MCG/HR PATCH fentanyl	00378912498 MYLAN	Yes	No	Medicaid CHIP CSHCN
FENTANYL 100 MCG/HR PATCH fentanyl	47781042847 ALVOGEN INC	Yes	No	Medicaid CHIP CSHCN
FENTANYL 12 MCG/HR PATCH fentanyl	47781042347 ALVOGEN INC	Yes	No	Medicaid CHIP CSHCN
FENTANYL 12 MCG/HR PATCH fentanyl	00378911998 MYLAN	Yes	No	Medicaid CHIP CSHCN
FENTANYL 25 MCG/HR PATCH fentanyl	47781042447 ALVOGEN INC	Yes	No	Medicaid CHIP CSHCN