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*Denotes a generic available in at least one dosage form or strength - page 17 / 26

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This PDL reference tool is to aid a prescribing physician with generic availability and preferred product status. A “substitution allowed” physician signature on a prescription should not require a PA to be obtained if a generic agent is available.

none

fentanyl

alfentanil morphine sulfate

oxycodone/ibuprofen propoxyphene napsylate/ acetaminophen propoxyphene HCL

oxycodone meperidine

hydromorphone methadone fentanyl morphine sulfate

codeine/acetaminophen/butalbital/ caffeine codeine/aspirin/butalbital/caffeine

levorphanol hydrocodone/acetaminophen hydrocodone/acetaminophen

hydrocodone/acetaminophen methadone hydrocodone/acetaminophen

oxycodone

dihydrocodeine/acetaminophen/caffeine oxycodone/acetaminophen oxycodone/aspirin

codeine/APAP/butalbital/caffeine

hydrocodone/ibuprofen

morphine sulfate oxycodone

fentanyl codeine/acetaminophen oxycodone/acetaminophen

Actiq* Alcet Alfenta* Astramorph* Capital w/codeine Combunox* Darvocet* Darvon* Darvon-N Dazidox* Demerol* Depodur Dilaudid* Dolophine* Duragesic* Duramorph* Fentora Fioricet w/codeine* Fiorinal w/codeine* Hycet Ibudone Infumorph Levo-Dromoran* Lorcet* Lortab* Lynox Magnacet Maxidone* Methadose* Norco* Nucynta** Numorphan Onsolis** Opana OxyIR* Panlor DC Panlor SS* Percocet* Percodan* Perloxx Phrenilin-Caffeine-Codeine* Primalev Reprexain* Roxanol* Roxicodone* Ryzolt Sublimaze* Tylenol w/codeine* Tylox* Ultiva

*Denotes a generic available in at least one dosage form or strength **Will be reviewed at a future time when eligible

Effective 4/1/2010

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