Exclusive - Opioid drug list update
Effective January 1, 2022
Benefit determination
The existence of this pharmacy policy does not mean that this service is a covered benefit under the member’s contract. Benefit determinations should be based in all cases on the applicable contract language. Pharmacy policies do not constitute a description of benefits. A member’s individual or group customer benefits govern which pharmaceuticals are covered, which are excluded, and which are subject to benefit limits and which require authorization. Members and providers should consult the member’s benefit information or contact us for benefit information.
Key:
UPPERCASE names = Brand
lowercase names = Generic
Analgesics - opioid
Drug name(s) |
Adult quantity limit – 5 days |
Child quantity limit – 3 days |
ABSTRAL SUB 400MCG |
120 tabs / 30 days |
N/A |
ABSTRAL SUB 600MCG |
120 tabs / 30 days |
N/A |
ABSTRAL SUB 800MCG |
120 tabs / 30 days |
N/A |
ACTIQ LOZENGE 1200MCG |
120 lozenges / 30 days |
N/A |
ACTIQ LOZENGE 1600MCG |
120 lozenges / 30 days |
N/A |
ACTIQ LOZENGE 200MCG |
120 lozenges / 30 days |
N/A |
ACTIQ LOZENGE 400MCG |
120 lozenges / 30 days |
N/A |
ACTIQ LOZENGE 600MCG |
120 lozenges / 30 days |
N/A |
ACTIQ LOZENGE 800MCG |
120 lozenges / 30 days |
N/A |
APAP/CAFFEINE TAB DIHYDROCODONE |
50 tablets/30 days |
30 tablets/30 days |
apap/codeine sol 120-12/5 |
450 mL/30 days |
270 mL/30 days |
apap/codeine tab 300-15mg |
30 tablets/30 days |
18 tablets/30 days |
apap/codeine tab 300-30mg |
30 tablets/30 days |
18 tablets/30 days |
apap/codeine tab 300-60mg |
25 tablets/30 days |
15 tablets/30 days |
APAP-CAFFEINE CAP DIHYDROCODONE |
50 capsules/30 days |
30 capsules/30 days |
ARYMO ER TAB 15MG |
60 tablets/month |
N/A |
ARYMO ER TAB 30MG |
30 tablets/month |
N/A |
ARYMO ER TAB 60MG |
0 tablets/month |
N/A |
BELBUCA MIS 150MCG |
60 films/month |
N/A |
BELBUCA MIS 300MCG |
60 films/month |
N/A |
BELBUCA MIS 450MCG |
60 films/month |
N/A |
BELBUCA MIS 600MCG |
60 films/month |
N/A |
BELBUCA MIS 750MCG |
60 films/month |
N/A |
BELBUCA MIS 75MCG |
60 films/month |
N/A |
BELBUCA MIS 900MCG |
30 films/month |
N/A |
buprenorphine dis 10mcg/hr |
4 systems/month |
N/A |
buprenorphine dis 15mcg/hr |
4 systems/month |
N/A |
buprenorphine dis 20mcg/hr |
4 systems/month |
N/A |
buprenorphine dis 5mcg/hr |
4 systems/month |
N/A |
buprenorphine dis 7.5/hr |
4 systems/month |
N/A |
butorphanol sol 10mg/ml |
2.5 mL (1 BOTTLE)/30 days |
0 mL/30 days |
BUTRANS DIS 10MCG/HR |
4 systems/month |
N/A |
BUTRANS DIS 15MCG/HR |
4 systems/month |
N/A |
BUTRANS DIS 20MCG/HR |
4 systems/month |
N/A |
BUTRANS DIS 5MCG/HR |
4 systems/month |
N/A |
BUTRANS DIS 7.5/HR |
4 systems/month |
N/A |
CODEINE SULF TAB 15MG |
30 tablets/30 days |
18 tablets/30 days |
CODEINE SULF TAB 30MG |
30 tablets/30 days |
18 tablets/30 days |
codeine sulf tab 30mg |
30 tablets/30 days |
18 tablets/30 days |
CODEINE SULF TAB 60MG |
25 tablets/30 days |
15 tablets/30 days |
codeine/apap tab 30-300mg |
30 tablets/30 days |
18 tablets/30 days |
codeine/apap tab 60-300mg |
25 tablets/30 days |
15 tablets/30 days |
CONZIP CAP 100MG |
30 capsules/30 days |
N/A |
CONZIP CAP 200MG |
30 capsules/30 days |
N/A |
CONZIP CAP 300MG |
30 capsules/30 days |
N/A |
DILAUDID LIQ 1MG/mL |
60 mL/30 days |
36 mL/30 days |
DILAUDID TAB 2MG |
30 tablets/30 days |
18 tablets/30 days |
DILAUDID TAB 4MG |
15 tablets/30 days |
9 tablets/30 days |
DILAUDID TAB 8MG |
5 tablets/30 days |
3 tablets/30 days |
DURAGESIC DIS 100MCG/H |
0 patches/month |
N/A |
DURAGESIC DIS 12MCG/HR |
10 patches/month |
N/A |
DURAGESIC DIS 25MCG/HR |
0 patches/month |
N/A |
DURAGESIC DIS 50MCG/HR |
0 patches/month |
N/A |
DURAGESIC DIS 75MCG/HR |
0 patches/month |
N/A |
dvorah tab |
50 tablets/30 days |
30 tablets/30 days |
endocet tab 2.5-325 |
60 tablets/30 days |
36 tablets/30 days |
endocet tab 5-325mg |
30 tablets/30 days |
18 tablets/30 days |
endocet tab 7.5-325 |
20 tablets/30 days |
12 tablets/30 days |
endocet tab 10-325mg |
15 tablets/30 days |
9 tablets/30 days |
fentanyl dis 12mcg/hr |
10 patches/month |
N/A |
fentanyl dis 25mcg/hr |
0 patches/month |
N/A |
fentanyl dis 50mcg/hr |
0 patches/month |
N/A |
fentanyl dis 75mcg/hr |
0 patches/month |
N/A |
fentanyl dis 100mcg/hr |
0 patches/month |
N/A |
fentanyl dis 37.5mcg |
0 patches/month |
N/A |
fentanyl dis 62.5mcg |
0 patches/month |
N/A |
fentanyl dis 87.5mcg |
0 patches/month |
N/A |
FENTANYL CIT TAB 100MCG |
120 tabs / 30 days |
N/A |
FENTANYL CIT TAB 200MCG |
120 tabs / 30 days |
N/A |
FENTANYL CIT TAB 400MCG |
120 tabs / 30 days |
N/A |
FENTANYL CIT TAB 600MCG |
120 tabs / 30 days |
N/A |
FENTANYL CIT TAB 800MCG |
120 tabs / 30 days |
N/A |
fentanyl ot loz 200mcg |
120 lozenges / 30 days |
N/A |
fentanyl ot loz 400mcg |
120 lozenges / 30 days |
N/A |
fentanyl ot loz 600mcg |
120 lozenges / 30 days |
N/A |
fentanyl ot loz 800mcg |
120 lozenges / 30 days |
N/A |
fentanyl ot loz 1200mcg |
120 lozenges / 30 days |
N/A |
fentanyl ot loz 1600mcg |
120 lozenges / 30 days |
N/A |
FENTORA TAB 100MCG |
120 tabs / 30 days |
N/A |
FENTORA TAB 200MCG |
120 tabs / 30 days |
N/A |
FENTORA TAB 400MCG |
120 tabs / 30 days |
N/A |
FENTORA TAB 600MCG |
120 tabs / 30 days |
N/A |
FENTORA TAB 800MCG |
120 tabs / 30 days |
N/A |
HYDROCODONE/ACETAMINOPHEN SOL 10-325MG |
375 mL/30 days |
225 mL/30 days |
hydrocodone/acetaminophen sol 10-325mg |
375 mL/30 days |
225 mL/30 days |
hydrocodone/apap sol 7.5-325 |
450 mL/30 days |
270 mL/30 days |
hydrocodone/apap tab 5-300mg |
40 tablets/30 days |
24 tablets/30 days |
hydrocdone/apap tab 5-325mg |
40 tablets/30 days |
24 tablets/30 days |
hydrocdone/apap tab 7.5-300 |
30 tablets/30 days |
18 tablets/30 days |
hydrocodone/apap tab 7.5-325 |
30 tablets/30 days |
18 tablets/30 days |
hydrocodone/apap tab 10-300mg |
25 tablets/30 days |
15 tablets/30 days |
hydrocodone/apap tab 10-325mg |
25 tablets/30 days |
15 tablets/30 days |
hydrocodone/ibuprofen tab 10-200mg |
25 tablets/30 days |
15 tablets/30 days |
HYDROCODONE/IBUPROFEN TAB 5-200MG |
25 tablets/30 days |
15 tablets/30 days |
hydrocodone/ibuprofen tab 5-200mg |
25 tablets/30 days |
15 tablets/30 days |
hydrocodone/ibuprofen tab 7.5-200 |
25 tablets/30 days |
15 tablets/30 days |
hydrocodone cap 10mg er |
60 capsules/30 days |
N/A |
hydrocodone cap 15mg er |
60 capsules/30 days |
N/A |
hydrocodone cap 30mg er |
30 capsules/30 days |
N/A |
hydrocodone cap 40mg er |
30 capsules/30 days |
N/A |
hydrocodone cap 50mg er |
30 capsules/30 days |
N/A |
HYDROCODONE CAP 10MG ER |
60 capsules/30 days |
N/A |
HYDROCODONE CAP 15MG ER |
60 capsules/30 days |
N/A |
HYDROCODONE CAP 20MG ER |
60 capsules/30 days |
N/A |
HYDROCODONE CAP 30MG ER |
30 capsules/30 days |
N/A |
HYDROCODONE CAP 40MG ER |
30 capsules/30 days |
N/A |
HYDROCODONE CAP 50MG ER |
30 capsules/30 days |
N/A |
hydrocodone tab 20mg er |
30 tablets/30 days |
N/A |
hydrocodone tab 30mg er |
30 tablets/30 days |
N/A |
hydrocodone tab 40mg er |
30 tablets/30 days |
N/A |
hydrocodone tab 60mg er |
0 tablets/30 days |
N/A |
hydrocodone tab 80mg er |
0 tablets/30 days |
N/A |
hydrocodone tab 100mg er |
0 tablets/30 days |
N/A |
hydrocodone tab 120mg er |
0 tablets/30 days |
N/A |
hydromorphone liq 1mg/ml |
60 mL/30 days |
36 mL/30 days |
hydromorphone tab 2mg |
30 tablets/30 days |
18 tablets/30 days |
hydromorphone tab 4mg |
15 tablets/30 days |
9 tablets/30 days |
hydromorphone tab 8mg |
5 tablets/30 days |
3 tablets/30 days |
hydromorphone tab 8mg er |
30 tablets/month |
N/A |
hydromorphone tab 12mg er |
30 tablets/month |
N/A |
hydromorphone tab 16mg er |
0 tablets |
N/A |
hydromorphone tab 32mg er |
0 tablets |
N/A |
HYSINGLA ER TAB 100 MG |
0 tablets/30 days |
N/A |
HYSINGLA ER TAB 120 MG |
0 tablets/30 days |
N/A |
HYSINGLA ER TAB 20 MG |
30 tablets/30 days |
N/A |
HYSINGLA ER TAB 30 MG |
30 tablets/30 days |
N/A |
HYSINGLA ER TAB 40 MG |
30 tablets/30 days |
N/A |
HYSINGLA ER TAB 60 MG |
0 tablets/30 days |
N/A |
HYSINGLA ER TAB 80 MG |
0 tablets/30 days |
N/A |
KADIAN CAP 10MG ER |
30 capsules/30 days |
N/A |
KADIAN CAP 20MG ER |
30 capsules/30 days |
N/A |
KADIAN CAP 30MG ER |
30 capsules/30 days |
N/A |
KADIAN CAP 40MG ER |
30 capsules/30 days |
N/A |
KADIAN CAP 50MG ER |
30 capsules/30 days |
N/A |
KADIAN CAP 60MG ER |
0 capsules/30 days |
N/A |
KADIAN CAP 80MG ER |
0 capsules/30 days |
N/A |
KADIAN CAP 100MG ER |
0 capsules/30 days |
N/A |
KADIAN CAP 200MG ER |
0 capsules/30 days |
N/A |
LAZANDA SPR 100MCG |
30 BOTTS / 30 days |
N/A |
LAZANDA SPR 300MCG |
30 BOTTS / 30 days |
N/A |
LAZANDA SPR 400MCG |
30 BOTTS / 30 days |
N/A |
levorphanol tab 2mg |
10 tablets/30 days |
6 tablets/30 days |
lorcet tab 5-325mg |
40 tablets/30 days |
24 tablets/30 days |
lorcet hd tab 10-325mg |
25 tablets/30 days |
15 tablets/30 days |
lorcet plus tab 7.5-325 |
30 tablets/30 days |
18 tablets/30 days |
LORTAB ELX 10-300MG |
338 mL/30 days |
203 mL/30 days |
MEPERIDINE SOL 50MG/5mL |
150 mL/30 days |
150 mL/30 days |
MEPERIDINE TAB 50MG |
30 tablets/30 days |
30 tablets/30 days |
METHADONE SOL 5MG/5mL |
300 mL/30 days |
N/A |
METHADONE SOL 10MG/5mL |
150 mL/30 days |
N/A |
methadone sol 5mg/5ml |
300 mL/30 days |
N/A |
methadone sol 10mg/5ml |
150 mL/30 days |
N/A |
methadone tab 5mg |
60 tablets/30 days |
N/A |
methadone tab 10mg |
30 tablets/30 days |
N/A |
MORPHABOND TAB 15MG ER |
60 tablets/30 days |
N/A |
MORPHABOND TAB 30MG ER |
30 tablets/30 days |
N/A |
MORPHABOND TAB 60MG ER |
0 tablets/30 days |
N/A |
MORPHABOND TAB 100MG ER |
0 tablets/30 days |
N/A |
morphine sul cap 10mg er |
30 capsules/30 days |
N/A |
morphine sul cap 20mg er |
30 capsules/30 days |
N/A |
morphine sul cap 30mg er |
30 capsules/30 days |
N/A |
morphine sul cap 50mg er |
30 capsules/30 days |
N/A |
morphine sul cap 60mg er |
0 capsules/30 days |
N/A |
morphine sul cap 80mg er |
0 capsules/30 days |
N/A |
morphine sul cap 100mg er |
0 capsules/30 days |
N/A |
MORPHINE SUL CAP 30MG ER |
30 capsules/30 days |
N/A |
MORPHINE SUL CAP 40MG ER |
30 capsules/30 days |
N/A |
MORPHINE SUL CAP 45MG ER |
30 capsules/30 days |
N/A |
MORPHINE SUL CAP 60MG ER |
0 capsules/30 days |
N/A |
MORPHINE SUL CAP 75MG ER |
0 capsules/30 days |
N/A |
MORPHINE SUL CAP 90MG ER |
0 capsules/30 days |
N/A |
MORPHINE SUL CAP 120MG ER |
0 capsules/30 days |
N/A |
morphine sul sol 10/0.5ml |
15 mL/30 days |
15 mL/30 days |
morphine sul sol 10mg/5ml |
125 mL/30 days |
75 mL/30 days |
morphine sul sol 20mg/5ml |
60 mL/30 days |
36 mL/30 days |
morphine sul sol 20mg/ml |
15 mL/30 days |
15 mL/30 days |
morphine sul sol 100/5ml |
15 mL/30 days |
15 mL/30 days |
morphine sul tab 15mg |
15 tablets/30 days |
9 tablets/30 days |
morphine sul tab 30mg |
5 tablets/30 days |
3 tablets/30 days |
MORPHINE SUL TAB 15MG |
15 tablets/30 days |
9 tablets/30 days |
MORPHINE SUL TAB 30MG |
5 tablets/30 days |
3 tablets/30 days |
morphine sul tab 100mg cr |
0 tablets/30 days |
N/A |
morphine sul tab 15mg er |
60 tablets/30 days |
N/A |
morphine sul tab 30mg er |
30 tablets/30 days |
N/A |
morphine sul tab 60mg er |
0 tablets/30 days |
N/A |
morphine sul tab 100mg er |
0 tablets/30 days |
N/A |
morphine sul tab 200mg er |
0 tablets/30 days |
N/A |
MS CONTIN TAB 15MG ER |
60 tablets/30 days |
N/A |
MS CONTIN TAB 30MG ER |
30 tablets/30 days |
N/A |
MS CONTIN TAB 60MG ER |
0 tablets/30 days |
N/A |
MS CONTIN TAB 100MG ER |
0 tablets/30 days |
N/A |
MS CONTIN TAB 200MG ER |
0 tablets/30 days |
N/A |
NORCO TAB 5-325MG |
40 tablets/30 days |
24 tablets/30 days |
NORCO TAB 7.5-325 |
30 tablets/30 days |
18 tablets/30 days |
NORCO TAB 10-325MG |
25 tablets/30 days |
15 tablets/30 days |
NUCYNTA TAB 50MG |
10 tablets/30 days |
6 tablets/30 days |
NUCYNTA TAB 75MG |
5 tablets/30 days |
3 tablets/30 days |
NUCYNTA TAB 100MG |
5 tablets/30 days |
3 tablets/30 days |
NUCYNTA ER TAB 50MG |
60 tablets/30 days |
N/A |
NUCYNTA ER TAB 100MG |
30 tablets/30 days |
N/A |
NUCYNTA ER TAB 150MG |
0 tablets/30 days |
N/A |
NUCYNTA ER TAB 200MG |
0 tablets/30 days |
N/A |
NUCYNTA ER TAB 250MG |
0 tablets/30 days |
N/A |
OPANA TAB 5MG |
15 tablets/30 days |
9 tablets/30 days |
OPANA TAB 10MG |
5 tablets/30 days |
3 tablets/30 days |
OXAYDO TAB 5MG |
30 tablets/30 days |
18 tablets/30 days |
OXAYDO TAB 7.5MG |
20 tablets/30 days |
12 tablets/30 days |
OXYCODONE/ACETAMINOPHEN SOL 10/300MG |
75 mL/30 days |
45 mL/30 days |
OXYCODONE/APAP TAB 10-300MG |
15 tablets/30 days |
9 tablets/30 days |
oxycodone/apap tab 5-325mg |
30 tablets/30 days |
18 tablets/30 days |
oxycodone/apap tab 10-325mg |
15 tablets/30 days |
9 tablets/30 days |
oxycodone/apap tab 2.5-325 |
60 tablets/30 days |
36 tablets/30 days |
oxycodone/apap tab 7.5-325 |
20 tablets/30 days |
12 tablets/30 days |
OXYCODONE/APAP TAB 5-300MG |
30 tablets/30 days |
18 tablets/30 days |
OXYCODONE/IBUPROFEN TAB 5-400MG |
20 tablets/30 days |
12 tablets/30 days |
OXYCODONE/ASA TAB |
30 tablets/30 days |
18 tablets/30 days |
oxycodone cap 5mg |
30 capsules/30 days |
18 capsules/30 days |
oxycodone cap hcl 5mg |
30 capsules/30 days |
18 capsules/30 days |
oxycodone con 10/0.5ml |
5 mL/30 days |
3 mL/30 days |
oxycodone con 100/5ml |
5 mL/30 days |
3 mL/30 days |
oxycodone sol 5mg/5ml |
165 mL/30 days |
99 mL/30 days |
oxycodone tab 5mg |
30 tablets/30 days |
18 tablets/30 days |
oxycodone tab 10mg |
15 tablets/30 days |
9 tablets/30 days |
oxycodone tab 15mg |
10 tablets/30 days |
6 tablets/30 days |
oxycodone tab 20mg |
5 tablets/30 days |
3 tablets/30 days |
oxycodone tab 30mg |
5 tablets/30 days |
3 tablets/30 days |
OXYCODONE TAB 10MG ER |
60 tablets/30 days |
N/A |
OXYCODONE TAB 15MG ER |
60 tablets/30 days |
N/A |
OXYCODONE TAB 20MG ER |
30 tablets/30 days |
N/A |
OXYCODONE TAB 30MG ER |
30 tablets/30 days |
N/A |
OXYCODONE TAB 40MG ER |
0 tablets/30 days |
N/A |
OXYCODONE TAB 60MG ER |
0 tablets/30 days |
N/A |
OXYCODONE TAB 80MG ER |
0 tablets/30 days |
N/A |
OXYCONTIN TAB 10MG CR |
60 tablets/30 days |
N/A |
OXYCONTIN TAB 15MG CR |
60 tablets/30 days |
N/A |
OXYCONTIN TAB 20MG CR |
30 tablets/30 days |
N/A |
OXYCONTIN TAB 30MG CR |
30 tablets/30 days |
N/A |
OXYCONTIN TAB 40MG CR |
0 tablets/30 days |
N/A |
OXYCONTIN TAB 60MG CR |
0 tablets/30 days |
N/A |
OXYCONTIN TAB 80MG CR |
0 tablets/30 days |
N/A |
OXYMORPHONE TAB 5MG ER |
60 tablets/30 days |
N/A |
OXYMORPHONE TAB 7.5MG ER |
60 tablets/30 days |
N/A |
OXYMORPHONE TAB 10MG ER |
30 tablets/30 days |
N/A |
OXYMORPHONE TAB 15MG ER |
30 tablets/30 days |
N/A |
OXYMORPHONE TAB 20MG ER |
0 tablets/30 days |
N/A |
OXYMORPHONE TAB 30MG ER |
0 tablets/30 days |
N/A |
OXYMORPHONE TAB 40MG ER |
0 tablets/30 days |
N/A |
oxymorphone tab hcl 5mg |
15 tablets/30 days |
9 tablets/30 days |
oxymorphone tab hcl 10mg |
5 tablets/30 days |
3 tablets/30 days |
pentazocine/naloxone tab 50-0.5mg |
10 tablets/30 days |
6 tablets/30 days |
PERCOCET TAB 2.5-325 |
60 tablets/30 days |
36 tablets/30 days |
PERCOCET TAB 5-325MG |
30 tablets/30 days |
18 tablets/30 days |
PERCOCET TAB 7.5-325 |
20 tablets/30 days |
12 tablets/30 days |
PERCOCET TAB 10-325MG |
15 tablets/30 days |
9 tablets/30 days |
PRImLEV TAB 5-300MG |
30 tablets/30 days |
18 tablets/30 days |
PRImLEV TAB 7.5-300 |
20 tablets/30 days |
12 tablets/30 days |
PRImLEV TAB 10-300MG |
15 tablets/30 days |
9 tablets/30 days |
PROLATE SOL 10/300MG |
75 mL/30 days |
45 mL/30 days |
QDOLO SOL 5MG/mL |
400 mL/30 days |
240 mL/30 days |
ROXICODONE TAB 5MG |
30 tablets/30 days |
18 tablets/30 days |
ROXICODONE TAB 15MG |
10 tablets/30 days |
6 tablets/30 days |
ROXICODONE TAB 30MG |
5 tablets/30 days |
3 tablets/30 days |
SUBSYS SPR 100MCG |
120 sprays/ 30 days |
N/A |
SUBSYS SPR 200MCG |
120 sprays/ 30 days |
N/A |
SUBSYS SPR 400MCG |
120 sprays/ 30 days |
N/A |
SUBSYS SPR 600MCG |
120 sprays/ 30 days |
N/A |
SUBSYS SPR 800MCG |
120 sprays/ 30 days |
N/A |
SUBSYS SPR 1200MCG |
240 sprays/ 30 days |
N/A |
SUBSYS SPR 1600MCG |
240 sprays/ 30 days |
N/A |
tramadol/apap tab 37.5-325 |
40 tablets/30 days |
24 tablets/30 days |
TRAMADOL HCL CAP 150MG ER |
30 capsules/30 days |
N/A |
TRAMADOL HCL CAP ER 100MG |
30 capsules/30 days |
N/A |
TRAMADOL HCL CAP ER 200MG |
30 capsules/30 days |
N/A |
TRAMADOL HCL CAP ER 300MG |
30 capsules/30 days |
N/A |
tramadolhcl tab 100mg er |
30 tablets/30 days |
N/A |
tramadolhcl tab 200mg er |
30 tablets/30 days |
N/A |
tramadolhcl tab 300mg er |
30 tablets/30 days |
N/A |
tramadolhcl tab 50mg |
50 tablets/30 days |
30 tablets/30 days |
TREZIX CAP |
50 capsules/30 days |
30 capsules/30 days |
TYLENOL/COD TAB #3 |
30 tablets/30 days |
18 tablets/30 days |
TYLENOL/COD TAB #4 |
25 tablets/30 days |
15 tablets/30 days |
ULTRACET TAB 37.5-325 |
40 tablets/30 days |
24 tablets/30 days |
ULTRAM TAB 50MG |
50 tablets/30 days |
30 tablets/30 days |
XTAMPZA ER CAP 13.5MG |
60 capsules/30 days |
N/A |
XTAMPZA ER CAP 9MG |
60 capsules/30 days |
N/A |
XTAMPZA ER CAP 18MG |
30 capsules/30 days |
N/A |
XTAMPZA ER CAP 27MG |
30 capsules/30 days |
N/A |
XTAMPZA ER CAP 36MG |
0 capsules/30 days |
N/A |
ZOHYDRO ER CAP 10MG |
60 capsules/30 days |
N/A |
ZOHYDRO ER CAP 15MG |
60 capsules/30 days |
N/A |
ZOHYDRO ER CAP 20MG |
60 capsules/30 days |
N/A |
ZOHYDRO ER CAP 30MG |
30 capsules/30 days |
N/A |
ZOHYDRO ER CAP 40MG |
30 capsules/30 days |
N/A |
ZOHYDRO ER CAP 50MG |
30 capsules/30 days |
N/A |