ANALGESICS: NARCOTICS LONG | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
FENTANYL 25 MCG/HR PATCH fentanyl	00378912198 MYLAN	Yes	No	Medicaid CHIP CSHCN
FENTANYL 50 MCG/HR PATCH fentanyl	47781042647 ALVOGEN INC	Yes	No	Medicaid CHIP CSHCN
FENTANYL 50 MCG/HR PATCH fentanyl	00378912298 MYLAN	Yes	No	Medicaid CHIP CSHCN
FENTANYL 75 MCG/HR PATCH fentanyl	47781042747 ALVOGEN INC	Yes	No	Medicaid CHIP CSHCN
FENTANYL 75 MCG/HR PATCH fentanyl	00378912398 MYLAN	Yes	No	Medicaid CHIP CSHCN
MORPHINE SULF ER 100 MG TABLET morphine sulfate	51862018801 MAYNE PHARMA IN	Yes	No	Medicaid CHIP CSHCN
MORPHINE SULF ER 100 MG TABLET morphine sulfate	00228432311 ACTAVIS/TEVA	Yes	No	Medicaid CHIP CSHCN
MORPHINE SULF ER 100 MG TABLET morphine sulfate	00904656061 MAJOR PHARMACEU	Yes	No	Medicaid CHIP CSHCN
MORPHINE SULF ER 100 MG TABLET morphine sulfate	42858080401 RHODES PHARMACE	Yes	No	Medicaid CHIP CSHCN
MORPHINE SULF ER 100 MG TABLET morphine sulfate	00406839001 MALLINCKRODT PH	Yes	No	Medicaid CHIP CSHCN