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 Analgesics Neuropathic or Chronic Pain
Pregabalin Lyrica 50 mg HS $35 BC - Covered / IA - SA Analgesics Neuropathic or Chronic Pain
Gabapentin Neurontin 300 mg TID $45 BC / IA - Covered Analgesics Neuropathic or Chronic Pain
Diclofenac/Misoprostol Arthrotec 75 mg/200 mcg BID $100 BC / IA - Covered Analgesics Non-Steroidal Antiinflammatory Drugs
Naproxen Naproxen 500 mg BID $55 BC / IA - Covered Analgesics Non-Steroidal Antiinflammatory Drugs
Ketorolac Toradol 10 mg BID $85 BC - Covered / IA - SA Analgesics Non-Steroidal Antiinflammatory Drugs
Naproxen/Esomeprazole Vimovo 500 mg/20 mg BID $205 BC / IA - NC Analgesics Non-Steroidal Antiinflammatory Drugs
Diclofenac Voltaren SR 75 mg BID $60 BC / IA - Covered Analgesics Non-Steroidal Antiinflammatory Drugs
Sumatriptan Imitrex 100 mg PRN $35 BC - SA / IA Covered

6 tablets

Analgesics Anti-Migraine
Zolmitriptan Zomig 2.5 mg PRN $40 BC - SA / IA Covered

6 tablets

Analgesics Anti-Migraine
Celecoxib Celebrex 200 mg QD $40 BC - SA / IA Covered Analgesics COX2 Inhibitor
Colchicine Colchicine 0.6 mg QD $40 BC / IA - Covered Analgesics Gout
Allopurinol Zyloprim 200 mg QD $25 BC / IA - Covered Analgesics Gout
Tramadol/Acetaminophen Tramacet 37.5 mg/325 mg PRN $80 BC / IA - NC

90 tablets

Analgesics Miscellaneous Analgesics
Amitriptyline Elavil 10 mg HS $20 BC / IA - Covered 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