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ANALGESIC AGENTS
ANALGESICS, NARCOTIC
** Ingredient Cost Per Therapy

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Brand/Generic Name Dosage/Strength Status Notes Ingredient Cost
Actiq generic.gif (400 bytes)
FentaNYL Citrate 		  nonform.gif (625 bytes) NOTES.gif (377 bytes) Unknown
Fentora
FentaNYL Citrate 		Tab   nonform.gif (625 bytes) NOTES.gif (377 bytes) Unknown
Onsolis
FentaNYL Citrate 		  nonform.gif (625 bytes) NOTES.gif (377 bytes) Unknown

Key for Product(s) Listed Above
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Formulary

(Brand non-formulary if Generic available)		 Click here for an explanation of these icons. 
Prior Authorization Required

(Once approved Brand and Generic, if available, are formulary)		 Click here for an explanation of these icons.
Non-Formulary

(Brand and Generic, if available, are non-formulary)
Click here for an explanation of these icons. Not Reimbursed Click here for an explanation of these icons. Generic Available Additional notes exist for this drug.Additional restrictions exist for this drug.Notes or Restrictions
  Click here for an explanation of these icons. Brand and Generic are Formulary  

Disclaimer: This is not a comprehensive list of all products covered on the formulary. Formulary status, ingredient cost, and/or copay may vary subject to availability of newly approved dosage forms and/or strengths.
If you have additional questions regarding your prescription drug benefit, please contact Member Services.

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