| Document Date: 2014-01-16 21:28:05
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City Accepted Formulary / / Company HP / / Event Person Communication and Meetings / / IndustryTerm pharmacy network / / MedicalCondition Drug Name Drug Requirements/ Tier Limits ANALGESICS GOUT / MS / / Organization Food and Drug Administration / New / Current / Medicare / / / Position prescribing physician / Governor / physician / / Product CELEBREX / lortab / probenecid / AVINZA / acetaminophen / ZYLOPRIM / MS CONTIN / fentanyl citrate / diflunisal / OPANA ER / MORPHINE SULFATE / ARTHROTEC / INFUMORPH / DURAGESIC / EC-NAPROSYN / ANAPROX DS / zydone / ULTRAM / ketoprofen / co-gesic / FIORINAL / ibuprofen / percocet / reprexain / DAYPRO / PERCODAN / ULTRACET / M-16 / VICOPROFEN / CLINORIL / roxicet / DILAUDID-HP / capital and codeine / NALFON / butalbital / ULTRAM ER / ROXICODONE / fioricet / SYNALGOS-DC / TYLENOL / etodolac / MELOXICAM / diclofenac sodium / CATAFLAM / ACTIQ / aloprim / OPANA / diclofenac potassium / fenoprofen calcium / tylox / norco / fentanyl / flurbiprofen / allopurinol / butorphanol tartrate / Maxalt / NAPRELAN / OXYCONTIN / nabumetone / MOBIC / vicodin / FELDENE / methadose / KADIAN / misoprostol / levorphanol tartrate / ANAPROX / FENTORA / DILAUDID / / URL http /
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HMSA’s 65C Plus (Cost) Prescription Drug Coverage 2013 Formulary List of Covered Drugs Last Updated November 2013