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*Denotes a generic available in at least one dosage form or strength - page 18 / 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.

tramadol/acetaminophen tramadol

tramadol hydrocodone/acetaminophen hydrocodone/ibuprofen

hydrocodone/acetaminophen

Ultracet* Ultram* Ultram ER* Vicodin* Vicoprofen* Vopac Xodol Xolox Zamicet* Zydone

codeine codeine/aspirin opium/belladonna propoxyphene HCL/acetaminophen

none

buprenorphine

pentazocine/acetaminophen

pentazocine/naloxone butorphanol nalbuphine

Buprenex* Suboxone Subutex Talacen* Talwin Talwin NX*

Maxalt Maxalt MLT Treximet

sumatriptan

Amerge Axert Frova Imitrex* Relpax Zomig Zomig ZMT

none

chlorzoxazone methocarbamol

tizanidine cyclobenzaprine

Amrix carisoprodol (generic) carisoprodol/aspirin (generic) carisoprodol/aspirin/codeine (generic) Fexmid Parafon Forte DSC* Robaxin* Skelaxin Soma* Soma Compound* Soma Compound w/codeine* Zanaflex*

none

dantrolene

Dantrium*

none

baclofen

Lioresal*

none

orphenadrine orphenadrine/aspirin/caffeine

Norflex*

*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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