L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT2 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT1 hydrocodonebit/acetaminophenT3 hydrocodonebit/acetaminophenT2 hydrocodonebit/acetaminophenT1 hydromorphone hclT3 hydromorphone hclT1 hydromorphone hclT3 hydromorphonehcl/pfT3 hydromorphonehcl/pfT1 hydromorphonehcl/pfT3 hydromorphonehcl/pfT1 hydromorphonehcl/pfT1 levorphanol tartrateT3 meperidine hcl/pfT1 meperidine hcl/pfT1 methadone hclT1 methadone hclT2 morphine sulfateT3 morphine sulfateT1 morphine sulfateT3 morphine sulfateT3 morphine sulfateT1 morphine sulfateT3 morphine sulfateLORCET PLUSQLLORTAB(SOLUTION) QLLORTAB(TAB)MAXIDONENORCOSTAGESIC-10VICODIN ESVICODIN HPZAMICETZYDONEDILAUDIDEXALGOHYDROMORPHONEHCLDILAUDID(AMPUL)(1MG/ML)DILAUDID(AMPUL)(2MG/ML)DILAUDID(AMPUL)(4MG/ML)DILAUDID-HPHYDROMORPHONEHCLLEVORPHANOLTARTRATEDEMEROLMEPERIDINE HCLDOLOPHINE HCLMETHADONE HCLAVINZAKADIAN(CAP ERPEL)(10 MG)KADIAN(CAP ERPEL)(100 MG)KADIAN(CAP ERPEL)(130 MG)KADIAN(CAP ERPEL)(150 MG)KADIAN(CAP ERPEL)(20 MG)KADIAN(CAP ERPEL)(200 MG)QLQLQLQLQLQLQLQLHYDROCODONE- QLACETAMINOPHEN(TAB)(5MG-300MG)HYDROCODONE- QLACETAMINOPHEN(TAB)(7.5-300MG)LORCET 10-650 QLT1 morphine sulfate KADIAN(CAP ERPEL)(30 MG)T3 morphine sulfate KADIAN(CAP ERPEL)(40 MG)T1 morphine sulfate KADIAN(CAP ERPEL)(50 MG)T1 morphine sulfate KADIAN(CAP ERPEL)(60 MG)T3 morphine sulfate KADIAN(CAP ERPEL)(70 MG)T1 morphine sulfate KADIAN(CAP ERPEL)(80 MG)T3 morphine sulfate MORPHINE SULFATEERT1 morphine sulfate MS CONTINT2 morphine sulfate ORAMORPH SRT3 morphine sulfate DEPODURliposomal/pfT3 morphineEMBEDAsulfate/naltrexoneT3 morphine sulfate/pf DURAMORPHT1 morphine sulfate/pf MORPHINESULFATE(PCASYRINGE)T3 morphine sulfate/pf MORPHINESULFATE(PCA VIAL)T1 morphine sulfate/pf MORPHINESULFATE(VIAL)T1 nalbuphine hcl NALBUPHINE HCLT1 opium/belladonnaalkaloidsBELLADONNA-OPIUMT1 oxycodone hcl DAZIDOXT3 oxycodone hcl OXECTAT1 oxycodone hcl OXYCODONE HCLT2 oxycodone hcl OXYCONTINT1 oxycodone hcl OXYIRT1 oxycodone hcl ROXICODONEINTENSOLT2 oxycodone hcl ROXICODONE(SOLUTION)T1 oxycodone hcl ROXICODONE(TAB)T3 oxycodoneMAGNACET QLhcl/acetaminophenT1 oxycodonePERCOCET QLhcl/acetaminophenT3 oxycodonePRIMALEVQLhcl/acetaminophenT3 oxycodonePRIMLEVQLhcl/acetaminophenT1 oxycodoneTYLOXQLhcl/acetaminophenT1 oxycodonePERCODANhcl/aspirinT1 oxycodoneOXYCODONEhcl/oxycodonter/asa ASPIRINT3 oxymorphone hcl NUMORPHANT3 oxymorphone hcl OPANA ERT3 oxymorphone hcl OPANA(AMPUL)T1 oxymorphone hcl OPANA(TAB)T1 pentazocine TALACENhcl/acetaminophenPage 48 of 91