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 |