Clickable Table

Generic Name	Brand Name	Strength	Dosing	90 Day Cost	Coverage	Comments	Category 1	Category 2
Amitriptyline	Elavil	25 mg	HS	$25	BC / IA - Covered		K Analgesics	Neuropathic or Chronic Pain
Pregabalin	Lyrica	50 mg	HS	$35	BC - Covered / IA - SA		K Analgesics	Neuropathic or Chronic Pain
Gabapentin	Neurontin	300 mg	TID	$45	BC / IA - Covered		K Analgesics	Neuropathic or Chronic Pain
Diclofenac/Misoprostol	Arthrotec	75 mg/200 mcg	BID	$100	BC / IA - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs
Naproxen	Naproxen	500 mg	BID	$55	BC / IA - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs
Ketorolac	Toradol	10 mg	BID	$85	BC - Covered / IA - SA		K Analgesics	Non-Steroidal Antiinflammatory Drugs
Naproxen/Esomeprazole	Vimovo	500 mg/20 mg	BID	$205	BC / IA - NC		K Analgesics	Non-Steroidal Antiinflammatory Drugs
Diclofenac	Voltaren SR	75 mg	BID	$60	BC / IA - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs
Sumatriptan	Imitrex	100 mg	PRN	$35	BC - SA / IA Covered	6 tablets	K Analgesics	Anti-Migraine
Zolmitriptan	Zomig	2.5 mg	PRN	$40	BC - SA / IA Covered	6 tablets	K Analgesics	Anti-Migraine
Celecoxib	Celebrex	200 mg	QD	$40	BC - SA / IA Covered		K Analgesics	COX2 Inhibitor
Colchicine	Colchicine	0.6 mg	QD	$40	BC / IA - Covered		K Analgesics	Gout
Allopurinol	Zyloprim	200 mg	QD	$25	BC / IA - Covered		K Analgesics	Gout
Tramadol/Acetaminophen	Tramacet	37.5 mg/325 mg	PRN	$80	BC / IA - NC	90 tablets	K Analgesics	Miscellaneous Analgesics
Amitriptyline	Elavil	10 mg	HS	$20	BC / IA - Covered		K Analgesics	Neuropathic or Chronic Pain

Legend:

BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection, SS=Social Services