PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)
PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)
PRESCRIPTION DRUG - Public Employees' Benefits Program (PEBP)
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$$$$ VYTORINQLL=30/Rx (ST) showing trial andfailure with lovastatin, pravastatin,simvastatinX$$$$$ CADUET QLL= 30 per fill/Rx X amlodipine, simvastatin, CRESTOR4.9 OTHER CARDIOVASCULAR <strong>DRUG</strong>S$ pentoxifylline (M) X$$ TRENTAL* (M) X pentoxifyllineCHAPTER 5: AUTONOMIC AND CNS MEDICATIONS5.1.1 Non-Narcotic Analgesics$ tramadol hcl (M) X$ tramadol/apap (M) X$$$$ RYZOLT (ST) history of tramadol X tramadol5.1.1.1 CLASS II NARCOTICS$ codeine phosphate X$ codeine sulfate X$$ hydromorphone (M) X$ meperidine hcl (M) X$$ methadone (M) X$ morphine sulfate IR X$$ morphine sulfate SR X$ oxycodone w/acetaminophen (M) X$ oxycodone/aspirin X$$$$ oxycodone ER hcl (M) (ST) history of morphine sulfate ER X$ oxycodone hcl (M) X$$$$$ ABSTRAL (PAR) cancer breakthrough pain X oxycodone!!!!! ACTIQ (PAR); Spec. Pharm. X oxycodone$$$$$ AVINZAQLL=30 tabs/Rx (ST) history ofgeneric long-acting opioid; Spec.Pharm.X$$$$$ BUTRANS NOT COVERED fentanyl$$$ DEMEROL* X meperidine hcl$$$$ DILAUDID* X hydromorphone$$$ DOLOPHINE* X methadoneEMBEDA 20/0.8, 30/1.2, 50/2.0, 60/2.4,100/4.0 MG (PAR) (ST) w/ failure of morphine X morphine$$$$$$$$ EXAGLO 8, 12, 16 mg (PAR) X!!!!! fentanyl Spec. Pharm. X!!!!! FENTORA (PAR)Spec. Pharm. X oxycodone!!!!! KADIAN(ST) history of generic long-actingopioid X morphine sulfate SR$ MSIR* X morphine suflate IR!!!!! MS CONTIN*(ST) history of generic long-actingopioid X morphine sulfate SR!!!!! NUCYNTA ER!!!!! OPANA!!!!! OPANA ERQLL= 180/month 18 years old &older. (ST) of 2 generic short actingnarcoticsoxycodone w/acetaminophen,hydrocodone w/acetaminophen,hydromorphoneXQLL=60 per fill (ST) history ofgeneric long-acting opioidXQLL=60 per fill (ST) history ofgeneric long-acting opioid X morphine sulfate SRQLL=60 tabs/Rx; Spec. Pharm.(ST) history of generic long-actingopioidXmorphine suflate IR, oxycodone,hydromorphone!!!!! OXYCONTIN*$ OXYIR* X oxycodone$$ PERCOCET* X oxycodone w/acetaminophen$$ PERCODAN* X oxycodone/aspirin5.1.1.2 CLASS III NARCOTICS$ acetaminophen w/codeine (M) X$ hydrocodone w/acetaminophen (M) X$ hydrocodone w/ibuprofen* X$$ LORCET* X hydrocodone w/acetaminophen$$ LORTAB* X hydrocodone w/acetaminophen$$ MAXIDONE* X hydrocodone w/acetaminophen$$ NORCO* X hydrocodone w/acetaminophen$$ TYLENOL W/ CODEINE X acetaminophen w/codeine$$ VICODIN* X hydrocodone w/acetaminophen$$ VICOPROFEN* X hydrocodone/ibuprofen5.1.2 <strong>DRUG</strong>S TO PREVENT AND TREAT HEADACHES$ butalbital/aspirin/caffeine (M) X$ butalbital/aspirin/caffeine/codeine (M) X$ butalbital/acetaminophen/caffeine (M) X$butalbital/acetaminophen/caffeine/codeine (M)X$ ergotamine/caffeine (M) X$ propranolol (M) X!!!!! AMERGEQLL=9 tabs/Rx (ST) history offilling generic sumatriptanQLL=6 tabs/Rx (ST) history ofXsumatriptan tablets, naratriptan,RELPAXsumatriptan tablets, naratriptan,RELPAX$$$$$ AXERTfilling generic sumatriptanX$$ CAFERGOT* X ergotamine/caffeine$$$ ESGIC*/ESGIC PLUS* X butalbital/acetaminophen/caffeine$$ FIORICET* X butalbital/acetaminophen/caffeine$$ FIORICET W/CODEINE Xbutalbital/acetaminophen/caffeine/codeine$$ FIORINAL* X butalbital/aspirin/caffeine$$ FIORINAL W/CODEINE X butalbital/aspirin/caffeine/codeine$$$$$ FROVAQLL=9 tabs/Rx (ST) history offilling generic sumatriptanXsumatriptan tablets, naratriptan,RELPAX!!!!! IMITREX TABLETS AND 12MG/ML VIAL QLL=9 tabs/Rx; X6 units/Rx (nasal Spray); 2vials/Rx!!!!! IMITREX NASAL AND STATDOSE (inj); 1Kit/Rx (inj kit)XQLL=9 tabs/Rx (ST) history of$$$$$ MAXALTfilling generic sumatriptanXQLL=9 tabs/Rx (ST) history of$$$$$ MAXALT MLTfilling generic sumatriptanX$$$$$ MIGRANAL QLL=1 bottle/Rx XQLL=9 tabs/Rx (ST) history of$$$$ naratriptanfilling generic sumatriptanXQLL = 9 tabs/Rx (ST) history of$$$$$ TREXIMETfilling one triptan and one NSAIDXQLL=6 tabs (ST) history of filling$$$$$ RELPAXgeneric sumatriptanXSumatriptan tablets, naratriptan,RELPAXsumatriptan tablets, naratriptan,RELPAXsumatriptan tablets, naratriptan,RELPAXsumatriptan tablets, naratriptan,RELPAX$$$$ sumatriptan tablets and 12mg/ml vial (M) QLL=9 tabs/Rx; 2vials/Rx (inj); XSUMATRIPTAN NASAL AND INJECTION 6 units/Rx (nasal Spray); 2vials/Rx!!!!! KITS(inj); 1Kit/Rx (inj kit)X7
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