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Pharmacy Resource GuideSeptember 2017 | Workers’ Compensation
3
Information contained in this Pharmacy Resource Guide is provided “as is” for informational purposes only and is not intended to constitute legal advice. Due to the rapidly changing nature of regulatory information, Optum does not warrant or guarantee the accuracy of content of this Guide. Before taking any action on the reimbursement or delivery of care based upon our Guide, the reader should consult their legal representatives.
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Table of Contents
4 2017 pharmacy state fee schedule detail
6 Maps of jurisdictional laws and regulations
12 2017 continuing education program, September to December 2017
13 Our perspective on opioid analgesics
14 Timeline of activity addressing opioid use in workers' comp and auto no-fault
16 Opioid analgesic laws
20 Brand-generic Index
25 Generic-brand Index
30 Opioid analgesic stats
31 Sources
We are pleased to share this Pharmacy Resource Guide offering insight on workers’ compensation jurisdictional laws and regulations, including a state-by-state guide to the pharmacy fee schedule along with updated statistics on opioid analgesics. We have also included a timeline of opioid analgesic legislative activity and medication releases spanning forty years, including our role in shaping the pharmacy benefit manager.
Additionally, we have included the remaining 2017 Continuing Education schedule and a helpful Brand-Generic Index of commonly used workers’ compensation medications.
Questions about our program may be shared with your account manager or clinical services.
Pharmacy Resource GuideSeptember 2017 | Workers' Compensation
4
2017 Pharmacy state fee schedule detailLegendBR = Brand Rate (% of AWP) + Dispense FeeGR = Generic Rate (% of AWP) + Dispense Fee
Reimbursement DescriptionPhysician Dispensed/RepackagedCompounded Medications
AK BR AWP + $5.00GR AWP + $10.00
Lesser of FS, fee to general public, or negotiated fee.
Reimbursement shall use the original manufacturer's AWP.
Reimbursement shall be limited to “medical necessity” and for each ingredient listed separately by NDC plus a $10 DF.
BR AWP + $5.13GR AWP + $5.13AR
Lesser of FS, provider’s U&C, or MCO/PPO contract price.
No DF to physicians. OTCs billed by physicians reimbursed at provider’s charge or up to 20% above cost of item. Dispensing practitioners must obtain permit (from state) and demonstrate need prior to dispensing approval.
BR AWP + 5% + $9.02GR AWP + 5% + $11.71AL
Lesser of FS or provider’s U&C.
Bills shall include original underlying NDC and NDC of repackaged/relabeled product. Reimbursement is lesser of original AWP and repackaged/relabeled AWP. DF payable only to pharmacies.
BR AWP - 5% + $7.00GR AWP - 15% + $7.00AZ
Reimbursement is based on actual medication dispensed. Medicines dispensed by either pharmacy or physician subject to FS.
Bills for physician dispensed/repackaged medications shall include NDC of medication dispensed and original manufacturer NDC. Reimbursement based on NDC of underlying medication product.
Reimbursement based on AWP of underlying medicine product and bills shall include NDC for each ingredient used.
BR AWP - 17% + $7.25GR AWP - 17% + $7.25CA
FS set at 100% of current Medi-Cal fee schedule. Lesser of AWP - 17% / MAC or FUL or U&C plus a DF.
If NDC of dispensed medication not in Medi-Cal but NDC of underlying medication is, use NDC of underlying medication. If NDC from original labeler not in Medi-Cal, max fee is 83% of AWP of lowest priced therapeutically equivalent medication plus relevant DF.
Billed using NDC of each ingredient. If no NDC, ingredient not reimbursable. Reimbursement for physician dispensed compounds not to exceed 300% of documented paid costs, or $20 above.
COIf AWP ceases, substitute with WAC + 20%.
For repackaged medications use AWP and NDC of underlying medication.
Rates for prescription strength topical compounds categorized according to four state-specific Z codes. Fees represent maximum reimbursable amount. All compound ingredients must be listed by quantity used. Certain topicals without a prescription are $30 for 30-day supply. Certain pain patches are $70 for a 30-day supply.
BR AWP + $4.00GR AWP + $4.00
CTReimbursement lesser of NDC for underlying medication from manufacturer or therapeutic equivalent medication product from manufacturer NDC. If information pertaining to original manufacturer is not provided or is unknown, payer may select NDC and associated AWP for reimbursement.
BR AWP + $5.00GR AWP + $8.00
DELesser of provider’s U&C, negotiated contract amount, or FS.
Reimbursement based on AWP for underlying medication product, as identified by its NDC, from original labeler. Physicians dispensing from office do not receive DF. No practitioner, unless properly licensed, shall dispense a controlled substance beyond a medically necessary 72-hour supply.
Billed listing each ingredient and separately calculating charge using NDC; single compounding fee of $10 per prescription.
BR AWP - 31.3% + $3.22 DFGR AWP - 37.5% + $4.02 DF
NMLesser of FS, U&C, or contracted rate.
Reimbursement at AWP - 10% with no DF. Initial physician dispense not greater than 10 days for new prescriptions. Provider dispensed medications shall not exceed cost of generic equivalent.
Reimbursed at ingredient level, plus single DF. Bills must include original NDC. Ingredients with no NDC not reimbursable.
BR AWP - 10% + $5.00GR AWP - 10% + $5.00
NDBased on a markup above WAC, except compounds.
Reimburses compounds at AWP - 72%, plus a single item compounding fee based on level of effort (LOE).
BR WAC + 8% + $4.00GR Lesser of: MAC + 5% or WAC + 8% + $5.00
MTLesser of FS or provider’s U&C.
Practice limited to certain exceptions.
BR AWP - 10% + $3.00GR AWP - 25% + $3.00
MSUnless contract, reimbursement is lesser of provider’s total billed charge or FS.
Reimbursed using NDC from underlying medication product from original labeler. DF not payable to doctors.
Bills shall include listing of each individual ingredient NDC. Reimbursement sum of AWPs of each underlying NDC medication product + $5 DF, and limited to a max of $300 per 120 grams per month quantity (without prior authorization).
BR AWP + $5.00GR AWP + $5.00
MNFS is bifurcated depending on paper billing and electronic or “real-time” billing and payment (as required) and includes MAC for GR.
Permitted if not for profit, or if for profit, physician must file with the appropriate licensing board and receive approval.
*Electronic. Paper for both BR and GR is AWP + $5.14
BR AWP - 12% + $3.65*GR AWP - 12% + $3.65*
MILesser of MAR in FS or provider’s U&C charge.
Billed and reimbursed based on original manufacturer’s NDC.
Reimbursement for “custom” compounds limited to max of $600 (charges exceeding subject to review). Topical compounds billed using specific amount of each ingredient and original manufacturer’s NDC. Reimbursed at max of AWP -10% of original manufacturer’s NDC, pro-rated for each ingredient, plus a specific DF. Ingredients without NDCs not reimbursed. Additional “medical necessity” requirements on custom and topical compounds. Non-compound OTC topicals addressed separately.
BR AWP - 10% + $3.50GR AWP - 10% + $5.50
MAFS tied to Medicaid rate.
Permitted only when necessary for immediate and proper treatment until possible for patient to have prescription filled by a pharmacy.
Additional DF amounts depending on type of ingredients.
BR Lowest of: MMAC, AAC or U&C + 10.02GR Lowest of: FUL, MMAC, AAC or U&C + 10.02
BR AWP + 10% + $10.51GR AWP + 40% + $10.51LA
DF is based on current state Medicaid DF.
Physicians may only dispense controlled substances or medications of concern if registered as a dispensing physician and only up to a single 48-hour supply.
Paid at FS formula for generics and bill must indicate “COMPOUND Rx” on form.
KYReimbursement at lower amount permitted if agreed.
Reimbursement based on AWP of original NDC. DF only payable to licensed pharmacist. Doctors are restricted to dispensing only a 48-hour supply of any CII or CIII medication containing hydrocodone from their office.
AWP of the compound medication is to be determined using the NDC of the original product from the manufacturer.
BR AWP + $5.00GR AWP*+ $5.00
*Of lowest priced therapeutically equivalent in stock
IDReimbursement is lesser of FS, billed charge, or charge agreed to pursuant to contract.
Reimbursement based on AWP of original manufacturer. Physicians not reimbursed a DF or compounding fee.
Reimbursed at sum of AWP of each individual medication, plus a $5 DF and $2 compounding fee. Ingredients of compounds require NDC of original manufacturer.
BR AWP + $5.00GR AWP + $8.00
HIRepackaged medications reimbursed at fee schedule based on original manufacturer NDC.
Reimbursed at fee schedule based upon gram weight of each underlying ingredient. AWP shall be set by the original manufacturer.
BR AWP + 40%GR AWP + 40%
GAReimbursement based on current published manufacturer’s AWP of product on date of dispensing.
Bills must include NDC of original manufacturer/distributor’s stock package.
Must be billed by the compounding pharmacy. Reimbursement shall be the sum of AWP for each ingredient -50% plus a single compound fee of $20. Reimbursement limited to compounds containing three or fewer active ingredients.
BR AWP + $4.31GR AWP + $6.45
FLReimbursement at FS except where employer/carrier or entity “acting on behalf of” employer/carrier directly contracts with provider seeking lower reimbursement.
AWP for repackaged/relabeled medications dispensed by “dispensing practitioner” shall be AWP of original manufacturer/underlying medication +12.5% + $8 DF. Must include original NDC.
Permitted when prescribed formulation not commercially available and reimbursement shall be AWP of each ingredient + $4.18 DF.
BR AWP + $4.18GR AWP + $4.18
NVLesser of FS, U&C, or contracted rate.
May dispense initial supply (15 days) of CII or CIII. Include original NDC on bills. May not charge or seek reimbursement for OTC.
Reimbursement based upon agreement and includes quantity prior to dispense. All compound bills shall list individual ingredients and NDC. Ingredients lacking an NDC shall not be reimbursed.
BR AWP + $10.94GR AWP + $10.94
KSLesser of FS or provider’s U&C.
Reimbursed at fee schedule based on original manufacturer’s NDC and require prior approval of carrier.
Same as physician dispensing.
BR AWP - 10% + $3.00GR AWP - 15% + $5.00
NCLesser of FS or an agreement between the provider/payer.
Original manufacturer's NDC required on bills for repackaged and doctor dispensed medications. Reimbursement for doctor dispensed medications shall not exceed 95% of AWP and based on AWP of the original NDC. No outpatient provider (other than pharmacies) may receive reimbursement for any CII through CV medications over an initial 5-day supply commencing on the employee's initial treatment.
BR AWP - 5%GR AWP - 5%
5
DC Paid at U&C.
IA Paid at U&C.
IL Insurer pays all necessary and reasonable costs.
Medications dispensed outside of licensed pharmacy are AWP + $4.18 and repackaged medications use AWP of underlying medication as identified by NDC from original labeler.
IN Reimbursement for repackaged medications dispensed (other than retail/mail pharmacy) use AWP of original manufacturer. If NDC not determined, max reimbursement is lowest cost generic for prescribed/dispensed medication.
Doctors dispensing medications from their office(s) are only entitled to receive reimbursement for medications dispensed during the first 7 days from DOI.
MD For medications or products lacking FS, carriers can assign a relative value to product/service. May be based on nationally recognized/published relative values or values assigned for similar products/services.
ME Paid at U&C.
MO Paid at U&C.
NE Paid actual charge billed unless payor has evidence exceeds regular charge for service by NE providers.
NH Pay reasonable value.
NJ Paid at U&C.
Physician dispensing limited to only 7-day supply unless more than 10 miles from nearest pharmacy. Additional limit on charges.
SD Not to exceed U&C.
UT Paid at U&C.
Physician dispensing permitted only in very limited situations.
VA Disputes use prevailing community rate.
Physician dispensing only permitted with certain specified limits (i.e., samples, emergency, not available) unless properly licensed by the Board of Pharmacy.
WV No Controlling Rx FS – Providers bill their U&C.
Legend medications dispensed by a physician will not be reimbursed except in emergency.
NO FEE SCHEDULE
Abbreviations: AAC = Actual Acquisition Cost AWP = Average Wholesale Price DAW = Dispense as Written DF = Dispensing Fee DFEC = Division of Federal Employees’ Compensation DNS = Do Not Substitute DOI = Date of Injury FS = Fee Schedule
FUL = Federal Upper Limit IW = Injured Worker MAC = Maximum Allowable Cost NDC = National Drug Code OTC = Over the Counter POS = Point of Sale SMN = Statement of Medical Necessity U&C = Usual and Customary WAC = Wholesale Acquisition Cost
ORLesser of FS, provider’s U&C, or contracted rate.
Compensability of physician dispensing limited to initial 10-day supply except in emergency.
Must be billed by ingredient, listing each ingredient's NDC (ingredients w/o NDC not reimbursable). Max fee = AWP-16.5% for each ingredient + a single $10 compounding fee.
BR AWP - 16.5% + $2.00GR AWP - 16.5% + $2.00
OKLesser of FS or provider’s U&C for same or similar service.
Physician dispensed (non–repackaged) lesser of AWP - 10% or payer’s contracted rate. Repackaged medications reimbursed at lesser of AWP for original NDC - 10% or AWP of lowest cost therapeutic equivalent medication - 10%.
Shall be billed by compounding pharmacy at the individual NDC ingredient level. Reimbursement shall be sum of allowable fee for each ingredient, plus a single $5 DF. Ingredients without NDC not reimbursed.
BR AWP - 10% + $5.00GR AWP - 10% + $5.00
OHLesser of U&C or FS.
Medications supplied to IW in physician’s office not considered outpatient medication and not reimbursed by BWC or MCO. Repackaged brand medications product cost component shall be calculated using AWP of original labeler (repackaged generics not addressed). Only pharmacy providers eligible for DF.
Billed and reimbursed based on ingredient NDCs (no reimbursement for ingredients without NDC). Max product cost component reimbursement for any one compounded Rx is $400. Dispensing fee(s) for non-sterile compounds shall be $18.75 and $37.50 for sterile compounds.
BR AWP - 15% + $3.50GR AWP - 15% + $3.50
NYFS or lower contracted rate.
Physician dispensing limited to 72 hours with exceptions. Repackaged medications reimbursed based on AWP for underlying medication.
Reimbursed at ingredient level. Payment based on sum of allowable fee for each ingredient, plus a single DF per compound. Ingredients with no NDC not reimbursable.
BR AWP - 12% + $4.00GR AWP - 20% + $5.00
PAIf provider’s actual charge less than FS, pay actual charge.
Reimbursement shall be at FS based on original manufacturer’s NDC, which must be submitted on bill. If original NDC is not submitted, reimbursement shall be FS of the least expensive clinically-equivalent medication. Outpatient providers (other than licensed pharmacies) may not seek reimbursement for Schedule II medication in excess of an initial 7-day supply commencing on “initial treatment” for specific WC claim. Should an IW require a “medical procedure,” one additional 15-day supply permitted, commencing on date of procedure. Providers may not seek reimbursement for any other prescription medications in excess of an initial 30-day supply, commencing on “initial treatment” by a provider for specific WC claim and may not seek reimbursement for an OTC medication.
BR AWP + 10%GR AWP + 10% WI
DF only payable to pharmacist. Reimbursed at existing pharmacy FS.
BR AWP + $3.00GR AWP + $3.00
WAL&I (state fund) does not pay for medication dispensed in physician’s office and policy is to not pay for repackaged medications.
Reimbursement allows cost of ingredients, plus a $4.50 professional fee and a $4 compounding time fee. Must be billed with NDC for each ingredient. Compounds require pre-authorization.
BR AWP - 10% + $4.50GR AWP - 50% + $4.50
VTLesser of FS or actual charge.
BR AWP + $3.15GR AWP + $3.15
TXReimbursement at compliant contracted rate (a direct contract with provider or through a registered pharmacy network) or lesser of FS or billed amount.
Physician dispensing only permitted to meet immediate needs or in rural area.
Calculate each ingredient separately (AWP in FS) plus a $15 compounding fee per prescription. Bills shall include each medication included in the compound.
BR AWP + 9% + $4.00GR AWP + 25% + $4.00
TNLesser of FS, provider’s U&C, or contracted rate.
Reimbursement based on published manufacturer’s AWP of product/ingredient, calculated on a per unit basis, on date of dispense. If original manufacturer’s NDC not provided on bill, reimbursement based on AWP of lowest priced therapeutically equivalent medication. Physician should not receive a DF.
Compounding fee not to exceed $25 per compound and may be charged by any entity other than physician. All compound bills shall include NDC of original manufacturer.
BR AWP + $5.10 GR AWP + $5.10
WYLesser of FS or provider’s U&C.
Physicians billing for compounds must provide pharmacy invoice and pay at 130% of supplier’s/manufacturer’s invoice price.
Compounding pharmacies that bill are compensated per FS, per line item if ingredient determined coverable. Pharmacists/third-party billers must submit itemization for all ingredients and quantities used in compounding process.
BR AWP - 10% + $5.00GR AWP - 10% + $5.00
RIPhysicians cannot bill for dispense, only for administered medications (injectable medications) in office.
Compounds containing repackaged medications shall be reimbursed using NDC of the underlying medication. Compounds shall be billed by separating the ingredients by NDC and corresponding quantity. Reimbursement for topical compounds shall not exceed $500 for a 30-day supply.
BR AWP - 10% GR AWP - 10%
SCLesser of FS or provider’s U&C.
Billed with original NDC and reimbursed accordingly. If original NDC not provided or unknown, payer shall select most closely associated AWP.
Billed by listing each ingredient NDC and reimbursed at sum of each NDC’s amount, plus a single $5 DF (payment not required for ingredients lacking an NDC).
BR AWP + $5.00GR AWP + $5.00 FEDERAL SERVICES
BR AWP - 15% + $4.00 DFEC AWP - 10% + $4.00 Non-DFEC
GR AWP - 40% + $4.00 DFEC AWP - 25% + $4.00 Non-DFEC
Lesser of FS or U&C charge amount.
For OWCP programs, all medications dispensed from physician’s office and submitted with codes J3490, J8499, J8999, and J9999 require accompanying original NDC. For FECA/Black Lung any doctor dispensed Rx submitted using CPT code 99070 require accompanying original NDC.
DFEC has specific prior-authorization processes for compounds. Compounds shall be billed at ingredient level, including NDCs. Reimbursement for compounds with three or less ingredients shall be AWP - 50% of each NDC. Reimbursement for compounds with four or more ingredients shall be AWP - 70% of each NDC.
Jurisdictional Generic Medication Mandates Substitution mandated
Substitution mandated except where prescriber notate DAW, DNS or similar
Substitution mandated except where written statement of medical necessity, prior authorization or other requirement provided/met
Substitution not specifically mandated for workers’ comp
6
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
HI
FIGURE 1
MEDICATION FORMULARIES AND GUIDELINES
None
WC Treatment Guidelines
WC Treatment Guidelines, as well as State WC Specific Formulary or Preferred Drug List (PDL)
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR*
CA
NV
ID
MT*
WY*
COUT
NMAZ
TX*
OK
KS
NE
SD
ND* MN
WI*
IL
IA
MO
AR
LA
AL
TN*
MIPA
NY
VT*
GA
FL*
MS
KY*
SC
NC
MDOH* DEIN WV*
NJCT
MA
ME*
RI
VA
NH
AK*
DC
HI
FIGURE 2
JURISDICTIONAL GENERIC MEDICATION MANDATES
Substitution mandated except where prescriber notate DAW, DNS or similar
Substitution not specifically mandated for WC
Substitution mandated except where written statement of medical necessity, prior authorization or other requirement provided/met
Substitution mandated
FIGURE 1: Reflects most current published jurisdictional workers’ compensation treatment guidelines or formularies (prescription medication utilization specific). Current as of August 2017.
FIGURE 2: DAW = Dispense as Written DNS = Do Not Substitute Data – Reflects published state statutes/regulations on generic dispensing. *Indicates injured worker can pay difference between brand and generic when brand dispensed without proper authorization. Current as of August 2017.
Maps of workers' comp (WC) jurisdictional laws and regulations
7
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA*
OR
CA
NV
ID
MT
WY
CO*UT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL*
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI*
VA
NH
AK
DC
HI
FIGURE 3
USE OF ORIGINAL NDC FOR REPACKAGED MEDICATIONS
No mandate for use of original NDC for billing/reimbursement
Mandates use of original NDC for billing and/or reimbursement
FIGURE 3: *Additional regulatory/statutory factors and qualifications may apply. Data – Reflects published statutes/regulations/case law on usage of underlying NDC for repackaged medications. Current as of August 2017.
FIGURE 4: FS = Fee Schedule MAR = Maximum Allowable Reimbursement U&C = Usual & Customary Charge | Note – Categories represent interpretation of state requirements. Some states use tiered/multiple levels of reimbursement. Data – Reflects published State Fee Schedules. Current as of August 2017.
Maps of WC jurisdictional laws and regulations
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
HI
FIGURE 4
DURABLE MEDICAL EQUIPMENT AND SUPPLIES STATE FEE SCHEDULE
Medicare allowable (may be +/– percentage markup)
State-established MAR
Not regulated or addressed/no specific FS established
Provider cost and/or invoice amount plus markup
Provider billed charge (may be +/– percentage markup)
U&C or reasonable amount
State Medicaid allowable
8
FIGURE 5: Note – States such as AR, DE, FL, KY, NY, and TN have overlapping workers’ compensation and state Practice Act controls. Data – Reflects published state statutes/regulations/case law on Physician Dispensing/Repackaging. Current as of August 2017.
FIGURE 6: Note – Categories set according to statute/regulation/case law relating to direction of care for pharmacy benefit/medical provider networks. Does not reflect dispensing physicians. Current as of August 2017.
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
HI
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
FIGURE 6
PHARMACY DIRECTION OF CARE
Statute/regulation silent or unclear
Potentially permitted with restrictions/qualifications
Prohibited by statute/ regulation/case law
Permitted under regulatory conditions
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
HI
FIGURE 5
PHYSICIAN DISPENSING/ REPACKAGING RESTRICTIONS
WC statutes/regulations limit physician dispensing and/or repackaging (restrictions on dispensing, billing, and/ or reimbursement).
No clear legal or WC limits on physician dispensing and/or repackaging
Legal restrictions on physician dispensing (Practice Act)
Legal restrictions (Practice Act) in addition to WC controls
Maps of WC jurisdictional laws and regulations
9
© 2016 Optum All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. -
WA*
OR
CA*
NV*
ID
MT
WY*
COUT
NMAZ
TX
OK*
KS*
NE
SD
ND* MN
WI
IL
IA
MO
AR
LA
AL
TN
MI* PA
NY*
VT
GA*
FL*
MS*
KY*
SC
NC
MDOH* DEIN WV
NJCT
MA
ME
RI*
VA
NH
AK*
DC
HI
FIGURE 7
COMPOUNDED MEDICATIONS
Not addressed by specific WC regulations/fee schedules
Individual ingredient(s) NDC required on compounded medications bills
Language explicitly permits denial of reimbursement for individual ingredients lacking an NDC
Unique state compounded medications reimbursement/ billing qualifiers and/or provisions
FIGURE 7: *Additional state regulatory/statutory language regarding billing and reimbursement for compounded medications (including physician dispensed compounded medications). Data – Reflects published statutes/regulations/fee schedules related to workers’ compensation compounded medication billing/ reimbursement. Current as of August 2017.
FIGURE 8: Note - Map reflects eBilling mandates inclusive of all workers’ compensation medical and pharmacy services. Data – Reflects published statutes regulations requiring eBilling or published implementation guides with an eBilling effective date. Current as of August 2017.
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
HI
FIGURE 8
eBILLING REGULATIONS
eBilling not mandated
Mandated on providers/payers
Regulations adopted but not mandated on providers
eBilling regulations under development or legislatively required to be developed
Maps of WC jurisdictional laws and regulations
10
FIGURE 9: Source: ProCon.org. Current as of August 2017. FIGURE 10: Data – Reflects current Naloxone policies. Source: pdaps.org. Current as of August 2017.
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
NMAZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN
WV
NJCT
MA
ME
RI
VA
NH
AK
DC
HI
FIGURE 10
NALOXONE
Naloxone access and medication overdose Good Samaritan laws
Naloxone access and Good Samaritan laws are limited and only applied to people under 21 who offer medical assistance to another experiencing an overdose from prescription medications
Naloxone access laws only
Maps of WC jurisdictional laws and regulations
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
AZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
NM*
HI
FIGURE 9
MEDICAL MARIJUANA
Legalized medical marijuana
Medical use of marijuana currently prohibited
Medical use of marijuana currently prohibited with legalized usage of cannabidiol (CBD) for limited purposes
Legalized recreational and medical marijuana
11
FIGURE 11
INITIAL OPIOID PRESCRIBING LIMITS
No recent policies enacted
Seven-Day Supply
Five-Day Supply
Three-Day Supply
Other – AR (schedule II and rule-making), MD (lowest effec-tive dose), NH (30-day acute; seven day in ER), NV (14-day), PA (hospitals and urgent care only), RI (MME Level), VT (MME Level), WA (rule-making)
FIGURE 11: Data – Reflects adoption of policies enacting initial opioid prescribing limits. Note – Initial days supply limitations can vary across jurisdictions. Additionally, these policies are not unique to workers’ compensation or auto no-fault. *Indicates requires rule-making/development to support full implementation. Current as of August 2017.
Maps of WC jurisdictional laws and regulations
© 2015 Helios. All rights reserved. Proprietary and confidential. Do not copy or distribute outside original intent. ACM14-15502
WA
OR
CA
NV
ID
MT
WY
COUT
AZ
TX
OK
KS
NE
SD
ND MN
WI
IL
IA
MO
AR
LA
AL
TN
MIPA
NY
VT
GA
FL
MS
KY
SC
NC
MDOH DEIN WV
NJCT
MA
ME
RI
VA
NH
AK
DC
NM*
HI
12
2017 Continuing Education program
AccreditationAll courses will be submitted for 1.0 hour of pre-approved Adjuster (AK, AL, CA, DE, FL, GA, IN, KY, LA, MS, NC, NH, OK, TX, UT, WY); Certified Case Manager (CCM); National Nurse; Certification of Disability Management Specialists (CDMS); Commission on Rehabilitation Counselor (CRC); and Certified Medicare Secondary Payer (CMSP) CE accreditation. For states that do not require prior approval, the adjuster will need to submit their attendance certificate to the appropriate state agency to determine if CE credits can be applied. The Settlement Solutions courses will also be submitted for 1.0 hour of Continuing Legal Education (IL, CA, FL, TX).
Approval information varies by course and will be updated on HeliosComp.com.
Continuing education credits for our courses are administered by the CEU Institute. If you have any issues or questions regarding your credits, please contact [email protected].
Register at HeliosComp.com/Resources/Education
Continuing Education courses and dates (September through December) All webinars will be held from 2:00-3:00 p.m. (EST)
October 26 . . . . . . . . Path to success when coordinating home health services
November 16 . . . . . . Major multiple trauma in workers' comp and auto no-fault
December 14 . . . . . . Using data to look beyond what you see
13
Our perspective on opioid analgesics
Opioid analgesics have a place in therapy; knowing when and how to use is key
The recent agreement between the U.S. Food and Drug Administration (FDA) and Endo Pharmaceuticals to have Opana® ER removed from the U.S. market highlights the ongoing need for awareness on the safety of opioid analgesics and a better understanding of how the medication can affect the major body systems. While this decision resulted from research determining the benefits of using reformulated Opana ER no longer outweigh its risks, the question of whether or not opioid analgesics should continue to have a place in medication therapy remains.
In our experience, a time and place for opioid analgesics exist in the treatment of injury-related pain. For post-surgical pain and acute injuries, such as fractures and crush injuries, the initial pain may not be controllable with non-opioid analgesics. It is during this early phase of the injury that short-acting opioid analgesics, such as hydrocodone and oxycodone, may be medically necessary and should be an available treatment option, if appropriate for the claimant and in accordance with prescribing and/or treatment guidelines. However, it is also during this timeframe, after the acute pain intensity decreases, that the plan for ongoing pain management should be developed and discussed with the claimant. When doing so, a straightforward approach is often the most effective. For instance, the prescriber may state the following… “this (opioid) medication will help control your pain over the next several days but it is not intended to be used on a long-term basis for this type of injury. Over the next couple of days, the amount of this medication being taken should be decreased and I am going to provide you with instructions on how to do this. At the same time, it is important to bring your pain under sufficient control while keeping you moving and active as your body starts to heal.”
Based on the individual claimant’s injury and specific circumstances, an expected date for discontinuing opioid analgesics should also be established before the first opioid prescription is filled. Furthermore, as with all medical treatments (pharmacologic and nonpharmacologic), the benefits of treatment need to outweigh the risks and the claimant should demonstrate understanding of those benefits and risks. While situations and complications may arise requiring a longer duration of pain management, additional non-opioid analgesic treatment measures should be incorporated, such as adjuvant pain medications, psychological evaluation and physical medicine treatments.
Opioid analgesics are not generally recommended for the ongoing (chronic) treatment of injury-related pain as they are often associated with increasing side effects, tolerance, drug-drug interactions, as well as the potential for abuse, misuse and addiction. However, for those claimants with chronic pain who are demonstrating a safe and compliant use of their opioid analgesic medications, along with well-documented and objective improvements in their level of function, the ongoing use of opioid analgesics at the minimally required dosage may not be, by itself, inappropriate. In fact, the early discontinuation of opioid analgesics in claimants with genuine pain symptoms can place some claimants at increased risks from the excessive use of other non-opioid analgesics, such acetaminophen and nonsteroidal anti-inflammatories. Therefore, a holistic view of the claimant’s current condition and risks to help make better decisions for their continued pain control and quality of life is essential.
14
Nearly 40 years ago, claimants faced difficulty having their claim-related, workers’ comp and auto no-fault prescriptions filled. Pharmacies often didn’t know how or where to invoice those prescriptions and thus were faced with potentially not being reimbursed for dispensing the medication. The introduction of the pharmacy benefit manager (PBM) resolved the access issue by introducing the use of a pharmacy network geared towards the processing of prescription transactions for particular payers, including workers’ comp and auto no-fault. PBM involvement also lowered pharmacy costs for payers as network discounts were applied to in-network transactions, reduced bill processing fees and other administrative inefficiencies and increased access to pharmacy data. In the years that follow, emphasis on driving transactions in-network remains paramount, particularly as pharmacy costs grow to approach nearly 20% of overall medical spend.
As network penetration increases, payers experience even lower pharmacy costs, become better equipped to holistically manage the claim, and the safety and efficacy of the claimant’s medication therapy improve. Programmatic business rules, drug utilization review criteria and injury-based formularies can be more refined and widespread. Advanced network enforcement capabilities along with improvements in electronic adjudication, including connectivity from pharmacy to payer, facilitate better monitoring and measurement of data. Increased knowledge about the dispensing process and pharmacy utilization yields better clinical management throughout the care continuum. As a result, payers start to see how better pharmacy management can influence overall medical spend, a claimant’s functional restoration and/or return to work and their overall health status.
As a pioneer in opioid management, Optum continues to collaborate with stakeholders throughout the system, leading the way towards healthier outcomes.
*BEFORE 1995: Early 1800’s: Morphine 1926: Dilaudid® 1942: Demerol® 1947: Dolophine® 1950: codeine 1950: Percodan®
1971: Percocet® 1983: Vicodin® 1986: Buprenex® 1987: MS Contin® 1990: Fiorinal® with codeine 1990: Duragesic® 1992: Fioricet® with codeine
*Reformulated to include abuse-deterrent properties. No medication is 100% abuse-deterrent. Medications in bold: Top 25 medications by spend
*Removed from market at FDA request
ONCE A PRESCRIPTION IS IN-NETWORK, YOU CAN ADDRESS UTILIZATION
MANAGING PHARMACY BENEFITS STARTS WITH THE NETWORK
AL CONV
NO REMARKABLE REGULATORY OR LEGISLATIVE ACTIVITY
Oxycontin®
Ultram®
Norco®
Vicoprofen® Roxicodone®
Kadian®
Ultracet®Actiq®
Avinza®
Subutex® Ultram® ERFentora®
Opana®*
1995* 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
A timeline of activity addressing opioid use in workers’ comp and auto no-faultMedication releases and regulatory and legislative activity
15
MANAGING PHARMACY UTILIZATION OFTEN REQUIRES CHANGE
THE MORE YOU KNOW, THE GREATER YOUR INFLUENCE
The ability to measure pharmacy activity allows PBMs and payers to act when the medication therapy regimen presents a concern. Identifying the need for change however, doesn’t automatically mean the change will occur. Often times a lack of expertise or resources along with competing priorities result in failure to take action. Similarly, incomplete health-related information or misinformation about a claimant’s entire treatment plan can cause prescribers to manage a claimant differently than they might otherwise, were more complete pharmacy information available.
To address these challenges, PBMs add a variety of outreach tools to facilitate multi-disciplined care coordination and information sharing. Pharmacist reviews, specialty-matched peer-to-peer evaluations, and the use of drug testing and monitoring (to name a few) are now deployed with greater frequency, much earlier in the claim lifecycle. When done correctly, this collaborative effort can have a dramatic effect: claimants receive the right medication at the right time, in the right dose and for the right duration. Meanwhile, payers avoid paying for the most expensive prescription; the one that should not have been paid in the first place.
With cost and utilization management tools in place, the PBM metamorphosis continues. There is an even greater focus on efforts to increase understanding within the payer community. Emphasis on enabling claims management professionals to take more proactive action also take center stage. Continuing education programs, interactive resource guides, white papers and other educational tools help payers dissect and better understand pharmacy and its influence on claim outcomes. The use of statistical analysis unleashes the predictive power of pharmacy data. As data and analytics pair with clinical expertise, payers intervene earlier in the lifecycle of those claims where their professional influence is needed most. These actions further drive down costs. Importantly, because the PBM has transformed into a provider of pharmacy care services, payers experience even greater value from their program starting with the first fill and enduring all the way through claim resolution and/or settlement due to increased administrative efficiency, shorter pharmacy claim duration, fewer instances of unnecessary medical use and spend, and safer, more appropriate and cost-effective care.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
ALCA
MN FLLAMATX
CTKYMAOHOK
DETXRIWA
MNNYOKOR
AZCOMIMNNVOR
AKARDEHIINKYLAMD
AZCACTMAMENH
NCNJNVOHUTVAWA
NYPARITNVT
MT
Suboxone®
Embeda®
Nucynta IR®
Onsolis®
Abstral®
Butrans®
Conzip®
Exalgo®
Lazanda®
Nucynta® EROpana ER®*Subsys®
Zubzolv®
Zohydro® ER
Troxyca® ER
Xtampza® ER
Zohydro® ER*
Probuphine
Bunavail®
Embeda®*oxycodone ER (generic OxyContin®)
Xartemis XR®
Belbuca®
Hyslinga® ER*Oxaydo®
*OxyContin®*
RoxyBond™
Opana® ER*Arymo™ ER*
16
Opioid analgesic laws
Abbreviations: CE = Continuing Education MED = Morphine Equivalency Dose MME = Morphine Milligram Equivalent PDMP = Prescription Drug Monitoring Program
Connecticut House Bill 5053 House Bill 7052 (2017 and 2018)Effective January 1, 2017
• Restricts the issuing of an initial prescription for an opioid analgesic to more than a seven-day supply.
• Provides exemptions for cancer treatment or at the professional judgment of the physician, however, this must be documented in the patient's file.
• Enhances reporting requirements for both prescribers and dispensing pharmacies with the state PDMP program.
• Limits issuing a prescription for an opioid analgesic medication for the first time to a maximum supply of seven days (effective July 1, 2017).
• Requires insurance companies in the state to provide coverage for substance abuse disorder.
• Requires all prescriptions of controlled substances to be done via ePrescribing (effective January 1, 2018).
Delaware RegulationEffective April 1, 2017
• Limits first time prescriptions of an opioid analgesic to treat acute pain to no more than a seven-day supply unless reasoning is documented and prescriber checks the state PDMP program.
• For subsequent prescriptions to treat acute pain, the prescriber shall be required to perform an appropriate evaluation of the medical condition, secure an informed consent document and check the state PDMP program.
• When treating for chronic pain, the prescriber shall complete all requirements (established by the licensing board) and check the PDMP at least once every six months.
Arkansas Senate Bill 339Effective April 3, 2017
• Requires Arkansas State Licensing Boards to develop rules limiting the amount of Schedule II opioid analgesic being prescribed and dispensed by licensees of the various Boards.
• Enhances requirements for prescribers to check the state PDMP program each time they prescribe a Schedule II or III opioid analgesic and for the initial prescription of a Benzodiazepine.
Alaska House Bill 159Effective July 26, 2017
• Limits initial opioid analgesic prescriptions to a seven-day supply.
• Permits prescriptions exceeding a seven-day supply if physician determines it to be medically necessary or under certain conditions to treat chronic pain.
• Requires development of continuing education requirements on issues such as opioid analgesic use, addiction and pain management.
Hawaii Senate Bill 505Effective July 1, 2017
• Limits initial concurrent opioid analgesic and benzodiazepine supply to seven days.
• Creates rules around prescribing of opioid analgesics and requires further action by Department of Health.
Indiana Senate Bill 226Effective July 1, 2017
• Initial opioid analgesic prescriptions limited to a seven-day supply.
• Requires development of additional prescribing rules by various medical licensing boards.
Kentucky House Bill 333Effective June 29, 2017
• Requires the Kentucky Office of Drug Control Policy and State Licensing Boards to establish prescribing limits for controlled substances.
• Requires limits for prescribing of any Schedule II medication for acute pain to a three-day supply and includes exemptions for chronic pain and end-of-life care.
• Rule-making currently in process.
17
Opioid analgesic laws
Abbreviations: CE = Continuing Education MED = Morphine Equivalency Dose MME = Morphine Milligram Equivalent PDMP = Prescription Drug Monitoring Program
Maine Legislative Draft 1646 and Senate Paper 671Effective July 28, 2016 (some changes made by LD 1031 in 2017)
• Imposes a seven-day supply limit on opioid analgesics when used to treat acute pain and a 30-day prescribing limit on opioid analgesics when used to treat chronic pain but recognizes treatment of certain conditions and end-of-life exemptions.
• Requires prescribers to check the PDMP every 90 days when prescribing opioid analgesics and for the initial prescription of any opioid analgesic and benzodiazepine.
• Requires dispensing pharmacies to check the PDMP if the person presenting an opioid prescription is not a Maine resident.
• Mandates prescribers complete at least three hours of CE on the subject of pain treatment and opioid addiction over a two-year period.
Louisiana House Bill 192Effective August 1, 2017
• Limits issuance of a first-time opioid analgesic prescription for a claimant with an acute condition to no more than a seven-day supply.
• Contains exemptions permitted for longer dosage if documented and justified by prescribing physician.
Maryland House Bill 1432Effective May 25, 2017
• Requires prescribing of the lowest effective dose of opioid analgesics.
• Requires prescribing of opioid analgesics to treat chronic pain to be based on evidence-based clinical guidelines.
Massachusetts House Bill 4056Effective December 1, 2016
• Limits the prescribing time frame for an initial prescription of any opioid analgesic to seven days with exemptions for the physicians’ professional judgment or certain end-of-life condition care.
• Requires prescribers in certain circumstances to engage in addiction risk assessment of the claimant and have the claimant execute an opioid treatment agreement prior to prescribing.
• Requires various state licensing boards to develop educational programs for prescribers and dispensers regarding the dangers, risks, and how to handle opioid addiction and overdose situations.
Nevada Assembly Bill 474Effective January 1, 2018
• Defines and limits initial prescription for a controlled substance to treat acute pain to an amount intended to be used for 14 days.
• Requires a prescription treatment agreement for prescribing of any controlled substance for more than 30 days for treatment of pain.
• Enhances existing PDMP reporting requirements and requires various licensing boards to develop continuing education programs on prescribing of opioid analgesics and opioid addiction.
New Hampshire Regulation (Via HB 1423)
Effective January 1, 2017• Prior to prescribing an opioid analgesic for the
treatment of acute pain, a prescriber must conduct a physical examination of the claimant, complete a board approved risk assessment and provide a written rationale for the opioid usage. Prescribers are not to exceed an initial seven-day supply.
• Prior to treatment of chronic pain, prescribers shall complete the initial requirements and shall prescribe the lowest effective dose for a limited duration; some end-of-life care conditions are exempted.
• All prescribers must register with the state PDMP program and before initial prescribing of any Schedule II, III or IV opioid analgesic(s) they must query the program.
18
Ohio RegulationEffective August 31, 2017
• Limits initial prescriptions for acute pain opioid analgesics to a seven-day supply.
• Limits ongoing prescriptions for acute pain with opioid analgesics to no more than 30 MED per day average.
• Permits doctors to exceed seven day initial and ongoing 30 MED average, if documented.
Pennsylvania House Bill 1699, Senate Bill 1202, Senate Bill 1368 (2016)
• HB 1699 limits the prescribing of opioid analgesics to seven days for claimants in a hospital emergency room, urgent care facility or under observation status in a hospital. Exempts patients being treated for cancer related pain and requires physician to indicate a non-opioid analgesic medication was inappropriate for the claimant before prescribing the opioid analgesic.
• SB 1202 requires all dispensers and prescribers to be registered with the state PDMP program. Additionally all prescribers must query the PMDP prior to prescribing an opioid analgesic or benzodiazepine and modifies reporting time for dispensing pharmacies to now be by the end of the business day.
• SB 1368 requires development of safe opioid analgesic prescribing curriculum in Pennsylvania medical schools and CE requirements for prescribers.
New York Senate Bill 8139Effective July 22, 2016
• For initial treatment of acute pain, practitioners may not prescribe more than a seven-day supply of any Schedule II, III or IV opioid analgesic; subsequent refills are subject to current prescribing limitations under law.
• Requires pharmacists to provide approved educational materials to a claimant when dispensing a controlled substance which must meet minimum requirements informing the patient of the risks of using a controlled substance.
• Implements new training requirements for medical professionals, including physicians and pharmacists on the practice of pain management, palliative care and addiction.
New Jersey Senate Bill 3Effective May 16, 2017
• Requires health insurers to provide benefits for substance abuse disorders.
• Limits the initial opioid analgesic prescription to a five-day supply for acute pain.
North Carolina House Bill 243Signed by Governor, Multiple Effective Dates
• Defines both acute and chronic pain.
• Limits prescriptions upon initial consultation for acute pain to more than a five-day supply of any targeted controlled substance.
• Makes additional enhancements to state PDMP program reporting requirements as well as requirements for ePrescribing of controlled substances.
Opioid analgesic laws
Abbreviations: CE = Continuing Education MED = Morphine Equivalency Dose MME = Morphine Milligram Equivalent PDMP = Prescription Drug Monitoring Program
Rhode Island House Bill 8224Effective June 28, 2016
• Limits initial prescriptions of opioid analgesics for acute pain to not exceed 30 MME total daily dose per day for a maximum of 20 days with exemptions for chronic pain under certain medical conditions.
• Mandates registration with the state PDMP program upon initial or renewal licensure application.
• Requires prescribers to review the state PDMP before starting any opioid analgesic therapy and at least once every three months for ongoing therapy. Pharmacies shall also report the dispensing of any opioid within one business day.
19
Opioid analgesic laws
Abbreviations: CE = Continuing Education MED = Morphine Equivalency Dose MME = Morphine Milligram Equivalent PDMP = Prescription Drug Monitoring Program
Utah House Bill 50Effective July 23, 2017
• Limits the prescribing of opioid analgesics (for workers’ compensation, auto and general health claimants) to seven days for acute conditions.
• Exempts pain related to surgery and the physician believes the seven-day supply is not adequate, the physician can prescribe up to 30 days. Also exempts certain documented chronic conditions.
• Requires prescribers to check the state PDMP program prior to dispensing the first fill of any opioid analgesic which exceeds three days or is not associated with surgery.
Vermont Regulation (Via SB 243)Effective July 1, 2017
• Provides full and clear definitions of acute and chronic pain and establishes treatment protocols with daily MME dosage levels for both.
• Categorizes acute pain into four specific levels of pain and establishes a ceiling of 50 MME/day for a seven-day supply of opioid analgesics.
• Defines chronic pain as pain lasting greater than 90 days and requires the prescriber to complete a medical examination and establishes a ceiling of 90 MME/day for treatment.
Virginia RegulationEffective September 14, 2017
• Initiation of opioid treatment for acute pain shall be with short-acting opioids and shall not exceed a seven-day supply.
• Prior to initiating treatment with a controlled substance containing an opioid, prescribers must query the state PDMP program.
• Requires prescribers to follow specific protocols when initiating treatment of chronic pain including UDM, developing a treatment plan and a query of the state PDMP program.
Washington House Bill 1427Effective July 23, 2017
• Requires rule development by various medical licensing boards regarding opioid analgesic prescription restrictions.
20
Brand-Generic Index
Brand Generic Therapeutic Class Pharmaceutical Uses†
Abilify® aripiprazole Antipsychotic Schizophrenia/Bipolar Disorder/Depression
Aciphex® rabeprazole Ulcer Drug Ulcers/GERD
Adderall® amphetamine/dextroamphetamine Stimulant Attention Deficit Hyperactivity Disorder
Advair Diskus® fluticasone/salmeterol Antiasthmatic Asthma/COPD
Advil® ibuprofen NSAID Pain/Inflammation
Altace® ramipril Antihypertensive High Blood Pressure/Heart Failure
Ambien CR® zolpidem ER Hypnotic Insomnia
Ambien® zolpidem Hypnotic Insomnia
Amitiza® lubiprostone Gastrointestinal Agent Constipation/Opioid-Induced Constipation
Amrix® cyclobenzaprine ER Skeletal Muscle Relaxant Muscle Spasm
Anaprox® DS naproxen sodium NSAID Pain/Inflammation
Androgel® testosterone Androgen Testosterone Deficiency
Antivert® meclizine Antiemetic Nausea/Vomiting
Arthrotec® diclofenac/misoprostol NSAID Pain/Inflammation
Arymo® ER morphine ER Opioid Analgesic Pain
Atarax® hydroxyzine Antianxiety Agent Anxiety/Itching
Ativan® lorazepam Antianxiety Agent Anxiety/Insomnia
Augmentin® amoxicillin/clavulanate potassium Antibiotic Bacterial Infections
Avinza® morphine ER Opioid Analgesic Pain
Bactrim® DS sulfamethoxazole/trimethoprim Antibiotic Bacterial Infections
Bactroban® mupirocin Antiinfective - Topical Skin Infections
BuSpar® buspirone Antianxiety Agent Anxiety
Butrans® buprenorphine Opioid Analgesic Pain
Bystolic® nebivolol Antihypertensive High Blood Pressure
Cataflam® diclofenac potassium NSAID Pain/Inflammation
Catapres® clonidine Antihypertensive High Blood Pressure
Celebrex® celecoxib NSAID Pain/Inflammation
Celexa® citalopram Antidepressant Depression
Cialis® tadalafil Misc Cardiovascular Erectile Dysfunction/Enlarged Prostate
Cipro® ciprofloxacin Antibiotic Bacterial Infections
Cleocin® clindamycin Antibiotic Bacterial Infections
Clinoril® sulindac NSAID Pain/Inflammation
Colace® docusate sodium Laxative Constipation
Combivent® Respimat® ipratropium bromide/albuterol Antiasthmatic COPD
Constulose® lactulose Laxative Constipation
Conzip® tramadol ER Opioid Analgesic Pain
Coreg® carvedilol Antihypertensive High Blood Pressure/Heart Failure
Coumadin® warfarin Anticoagulant Blood Thinner
Cozaar® losartan potassium Antihypertensive High Blood Pressure
Crestor® rosuvastatin Antihyperlipidemic High Cholesterol
Cymbalta® duloxetine Antidepressant Depression/Pain/Anxiety
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
21
Brand-Generic Index
Brand Generic Therapeutic Class Pharmaceutical Uses†
Daypro® oxaprozin NSAID Pain/Inflammation
Deltasone® prednisone Corticosteroid Inflammatory Disorders
Depakote® divalproex Anticonvulsant Seizures/Migraine/Bipolar Disorder
Depakote® ER divalproex ER Anticonvulsant Seizures/Migraine/Bipolar Disorder
Desyrel® trazodone Antidepressant Depression/Insomnia
Dexilant™ dexlansoprazole Ulcer Drug Ulcers/GERD
Dilantin® phenytoin Anticonvulsant Seizures
Dilaudid® hydromorphone Opioid Analgesic Pain
Diovan® valsartan Antihypertensive High Blood Pressure/Heart Failure
Ditropan XL® oxybutynin ER Urinary Antispasmodic Overactive Bladder
Dolophine® methadone Opioid Analgesic Pain
Duexis® ibuprofen/famotidine NSAID/Histamine Blocker Arthritis/Ulcer Risk Reduction
Dulcolax® Suppository bisacodyl Laxative Constipation
Duragesic® fentanyl Opioid Analgesic Pain
EC-Naprosyn® naproxen delayed-release NSAID Pain/Inflammation
Ecotrin® aspirin Non-Opioid Analgesic Pain/Inflammation/Fever
Effexor® venlafaxine Antidepressant Depression
Effexor® XR venlafaxine ER Antidepressant Depression
Elavil® amitriptyline Antidepressant Depression/Insomnia/Nerve Pain
Eliquis® apixaban Anticoagulant Blood Thinner
Embeda® morphine/naltrexone Opioid Analgesic Pain
Esgic®/Fioricet® butalbital/acetaminophen/caffeine Non-Opioid Analgesic Headache
Exalgo® hydromorphone ER Opioid Analgesic Pain
Feldene® piroxicam NSAID Pain/Inflammation
Flector® Patch diclofenac patch Topical NSAID Pain/Inflammation
Flexeril® cyclobenzaprine Skeletal Muscle Relaxant Muscle Spasm
Flomax® tamsulosin Misc Genitourinary Product Enlarged Prostate
Flonase® fluticasone Corticosteroid - Nasal Allergies
Glucophage® metformin Antidiabetic High Blood Sugar
Gralise® gabapentin Anticonvulsant Nerve Pain
Horizant® gabapentin enacarbil Anticonvulsant Restless Legs Syndrome
Hydrodiuril® hydrochlorothiazide Diuretic High Blood Pressure/Heart Failure
Hysingla® ER hydrocodone ER Opioid Analgesic Pain
Imitrex® sumatriptan Migraine Product Migraine
Inderal® propranolol Antihypertensive High Blood Pressure/Migraine
Inderal® LA propranolol ER Antihypertensive High Blood Pressure/Migraine
Isentress® raltegravir Antiviral Human Immunodeficiency Virus Infection
Kadian® morphine ER Opioid Analgesic Pain
Keflex® cephalexin Antibiotic Bacterial Infections
Kenalog® triamcinolone Corticosteroid - Topical Inflammatory Disorders
Keppra® levetiracetam Antianxiety Agent Seizures
Klonopin® clonazepam Anticonvulsant Seizures/Panic Disorder
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
22
Brand-Generic Index
Brand Generic Therapeutic Class Pharmaceutical Uses†
Klor-Con® potassium chloride Mineral & Electrolyte Potassium Deficiency
Lamictal® lamotrigine Anticonvulsant Seizures/Bipolar Disorder
Lasix® furosemide Diuretic High Blood Pressure/Heart Failure
Levaquin® levofloxacin Antibiotic Bacterial Infections
Lexapro® escitalopram Antidepressant Depression
Lidoderm® Patch lidocaine patch Topical Analgesic - Anesthetic Nerve Pain
Linzess® linaclotide Gastrointestinal Agent Constipation/Irritable Bowel Syndrome
Lioresal® baclofen Skeletal Muscle Relaxant Spasticity
Lipitor® atorvastatin Antihyperlipidemic High Cholesterol
Lodine® etodolac NSAID Pain/Inflammation
Lodine® ER etodolac ER NSAID Pain/Inflammation
Lopressor® metoprolol tartrate Antihypertensive High Blood Pressure/Angina
Lovenox® enoxaparin Anticoagulant Blood Thinner
Lunesta® eszopiclone Hypnotic Insomnia
Lyrica® pregabalin Anticonvulsant Fibromyalgia/Seizures/Nerve Pain
Medrol® methylprednisolone Corticosteroid Inflammatory Disorders
Minipress® prazosin Antihypertensive High Blood Pressure
MiraLAX® polyethylene glycol Laxative Constipation
Mobic® meloxicam NSAID Pain/Inflammation
Movantik® naloxegol Gastrointestinal Agent Opioid-Induced Constipation
Moxatag® amoxicillin ER Antibiotic Bacterial Infections
MS Contin® morphine ER Opioid Analgesic Pain
Naprosyn® naproxen NSAID Pain/Inflammation
Neurontin® gabapentin Anticonvulsant Seizures/Nerve Pain
New Terocin Lotion methyl salicylate/capsaicin/menthol Dermatological - Topical Topical Pain Relief
Nexium® esomeprazole magnesium Ulcer Drug Ulcers/GERD
Norco® hydrocodone/acetaminophen Opioid Analgesic Pain
Norflex® orphenadrine Skeletal Muscle Relaxant Muscle Spasm
Norvasc® amlodipine Antihypertensiver High Blood Pressure/Angina
Nucynta® tapentadol Opioid Analgesic Pain
Nucynta® ER tapentadol ER Opioid Analgesic Pain
Nuvigil® armodafinil Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder
Opana® oxymorphone Opioid Analgesic Pain
Orudis® ketoprofen NSAID Pain/Inflammation
OxyContin® oxycodone ER Opioid Analgesic Pain
Pamelor® nortriptyline Antidepressant Depression/Insomnia/Nerve Pain
Parafon Forte® DSC chlorzoxazone Skeletal Muscle Relaxant Muscle Spasm
Paxil® paroxetine Antidepressant Depression
Pennsaid® Solution diclofenac solution Topical NSAID Pain/Inflammation
Pepcid® famotidine Ulcer Drug Ulcers/GERD
Percocet® oxycodone/acetaminophen Opioid Analgesic Pain
Phenergan® promethazine Antihistamine Nausea/Vomiting
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
23
Brand-Generic Index
Brand Generic Therapeutic Class Pharmaceutical Uses†
Plavix® clopidogrel Hematological Post Stroke/Heart Attack
Pred Forte® prednisolone Ophthalmic Eye Inflammation
Prevacid® lansoprazole Ulcer Drug Ulcers/GERD
Prilosec® omeprazole Ulcer Drug Ulcers/GERD
Pristiq® desvenlafaxine ER Antidepressant Depression
ProAir® HFA albuterol sulfate Antiasthmatic Asthma
Protonix® pantoprazole Ulcer Drug Ulcers/GERD
Provigil® modafinil Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder
Prozac® fluoxetine Antidepressant Depression
Relafen® nabumetone NSAID Pain/Inflammation
Remeron® mirtazapine Antidepressant Depression
Requip® ropinirole Antiparkinsonian Parkinson's Disease/Restless Legs Syndrome
Restoril™ temazepam Hypnotic Insomnia
Risperdal® risperidone Antipsychotic Schizophrenia/Bipolar Disorder
Ritalin® methylphenidate Stimulant Attention Deficit Hyperactivity Disorder
Robaxin® methocarbamol Skeletal Muscle Relaxant Muscle Spasm
Roxicodone® oxycodone Opioid Analgesic Pain
Senokot® sennosides Laxative Constipation
Senokot-S® senna/docusate sodium Laxative Constipation
Seroquel XR® quetiapine ER Antipsychotic Schizophrenia/Bipolar Disorder/Depression
Seroquel® quetiapine Antipsychotic Schizophrenia/Bipolar Disorder
Silvadene® silver sulfadiazine Antiinfective - Topical Burn Wound
Sinequan® doxepin Antidepressant Depression/Insomnia
Singulair® montelukast Antiasthmatic Asthma/Allergic Rhinitis
Skelaxin® metaxalone Skeletal Muscle Relaxant Muscle Spasm
Soma® carisoprodol Skeletal Muscle Relaxant Muscle Spasm
Spiriva® Handihaler® tiotropium Antiasthmatic COPD
Suboxone® buprenorphine/naloxone Opioid Analgesic Opioid dependence
Subutex® buprenorphine Opioid Analgesic Opioid dependence
Symbicort® budesonide/formoterol Antiasthmatic Asthma/COPD
Synthroid® levothyroxine Thyroid Thyroid Hormone Deficiency
Tegretol® carbamazepine Anticonvulsant Seizures/Bipolar Disorder/Nerve Pain
Tenormin® atenolol Antihypertensive High Blood Pressure/Angina
Terocin Patch lidocaine/menthol Dermatological - Topical Topical Pain Relief
Tivorbex® indomethacin NSAID Pain/Inflammation
Topamax® topiramate Anticonvulsant Seizures/Migraine
Toprol-XL® metoprolol ER Antihypertensive High Blood Pressure/Heart Failure/Angina
Toradol® ketorolac NSAID Pain/Inflammation
Tricor® fenofibrate Antihyperlipidemic High Cholesterol
Trileptal® oxcarbazepine Anticonvulsant Seizures
Trintellix® vortioxetine Antidepressant Depression
Truvada® emtricitabine/tenofovir Antiviral Human Immunodeficiency Virus Infection
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
24
Brand Generic Therapeutic Class Pharmaceutical Uses†
Tylenol® Extra Strength acetaminophen extra-strength Non-Opioid Analgesic Pain/Fever
Tylenol® with Codeine #3
acetaminophen/codeine Opioid Analgesic Pain
Ultracet® tramadol/acetaminophen Opioid Analgesic Pain
Ultram® tramadol Opioid Analgesic Pain
Ultram® ER tramadol ER Opioid Analgesic Pain
Valium® diazepam Antianxiety Agent Anxiety/Muscle spasms
Ventolin®/Proventil® albuterol nebulizer solution Antiasthmatic Asthma
Viagra® sildenafil Misc Cardiovascular Erectile Dysfunction/Pulmonary Hypertension
Vibramycin® doxycycline hyclate Antibiotic Bacterial Infections
Vicoprofen® hydrocodone/ibuprofen Opioid Analgesic Pain
Viibryd® vilazodone Antidepressant Depression
Vimovo® naproxen/esomeprazole NSAID/Proton Pump Inhibitor Arthritis/Ulcer Risk Reduction
Vistaril® hydroxyzine pamoate Antianxiety Agent Anxiety/Itching
Voltaren® diclofenac NSAID Pain/Inflammation
Voltaren® Gel diclofenac gel Topical NSAID Pain/Inflammation
Voltaren®-XR diclofenac ER NSAID Pain/Inflammation
Wellbutrin XL® bupropion ER Antidepressant Depression
Wellbutrin® bupropion Antidepressant Depression
Xanax® alprazolam Antianxiety Agent Anxiety/Panic Disorder
Xarelto® rivaroxaban Anticoagulant Blood Thinner
Xylocaine® lidocaine ointment Dermatological - Topical Numbing/Nerve Pain
Zanaflex® tizanidine Skeletal Muscle Relaxant Muscle Spasm
Zantac® ranitidine Ulcer Drug Ulcers/GERD
Zestril® lisinopril Antihypertensive High Blood Pressure/Heart Failure
Zetia® ezetimibe Antihyperlipidemic High Cholesterol
Zipsor® diclofenac potassium NSAID Pain/Inflammation
Zithromax® azithromycin Antibiotic Bacterial Infections
Zocor® simvastatin Antihyperlipidemic High Cholesterol
Zofran® ondansetron Antiemetic Nausea/Vomiting
Zoloft® sertraline Antidepressant Depression
Zonegran® zonisamide Anticonvulsant Seizures
Zorvolex® diclofenac NSAID Pain/Inflammation
Zyprexa® olanzapine Antipsychotic Schizophrenia/Bipolar Disorder/Depression
Brand-Generic Index
DISCLAIMERS: The information is provided AS IS, for informational purposes only, and is not intended to constitute medical advice or to be used for diagnostic or treatment purposes. Optum does not warrant or guarantee the accuracy of this information and is not responsible for any results obtained from its use. Contact a physician or other health care provider before taking any medical action based on this information, including changes to medication therapy. Readers are encouraged to confirm information independently and/or consult with their legal representatives.NOTE: Company and product names mentioned are either registered trademarks or trademarks of their respective users. Some brand name products are no longer on the market. Furthermore, if a generic medication is commercially available, not all strengths may have a generic equivalent.
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
25
Generic-Brand Index
Generic Brand Therapeutic Class Pharmaceutical Uses†
acetaminophen extra-strength Tylenol® Extra Strength Non-Opioid Analgesic Pain/Fever
acetaminophen/codeine Tylenol® with Codeine #3 Opioid Analgesic Pain
albuterol nebulizer solution Ventolin®/Proventil® Antiasthmatic Asthma
albuterol sulfate ProAir® HFA Antiasthmatic Asthma
alprazolam Xanax® Antianxiety Agent Anxiety/Panic Disorder
amitriptyline Elavil® Antidepressant Depression/Insomnia/Nerve Pain
amlodipine Norvasc® Antihypertensive High Blood Pressure/Angina
amoxicillin ER Moxatag® Antibiotic Bacterial Infections
amoxicillin/ clavulanate potassium
Augmentin® Antibiotic Bacterial Infections
amphetamine/ dextroamphetamine
Adderall® Stimulant Attention Deficit Hyperactivity Disorder
apixaban Eliquis® Anticoagulant Blood Thinner
aripiprazole Abilify® Antipsychotic Schizophrenia/Bipolar Disorder/Depression
armodafinil Nuvigil® Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder
aspirin Ecotrin® Non-Opioid Analgesic Pain/Inflammation/Fever
atenolol Tenormin® Antihypertensive High Blood Pressure/Angina
atorvastatin Lipitor® Antihyperlipidemic High Cholesterol
azithromycin Zithromax® Antibiotic Bacterial Infections
baclofen Lioresal® Skeletal Muscle Relaxant Spasticity
bisacodyl Dulcolax® Suppository Laxative Constipation
budesonide/formoterol Symbicort® Antiasthmatic Asthma/COPD
buprenorphine Butrans® Opioid Analgesic Pain
buprenorphine Subutex® Opioid Analgesic Opioid dependence
buprenorphine/naloxone Suboxone® Opioid Analgesic Opioid dependence
bupropion Wellbutrin® Antidepressant Depression
bupropion ER Wellbutrin XL® Antidepressant Depression
buspirone BuSpar® Antianxiety Agent Anxiety
butalbital/acetaminophen/ caffeine
Esgic®/Fioricet® Non-Opioid Analgesic Headache
carbamazepine Tegretol® Anticonvulsant Seizures/Bipolar Disorder/Nerve Pain
carisoprodol Soma® Skeletal Muscle Relaxant Muscle Spasm
carvedilol Coreg® Antihypertensive High Blood Pressure/Heart Failure
celecoxib Celebrex® NSAID Pain/Inflammation
cephalexin Keflex® Antibiotic Bacterial Infections
chlorzoxazone Parafon Forte® DSC Skeletal Muscle Relaxant Muscle Spasm
ciprofloxacin Cipro® Antibiotic Bacterial Infections
citalopram Celexa® Antidepressant Depression
clindamycin Cleocin® Antibiotic Bacterial Infections
clonazepam Klonopin® Anticonvulsant Antianxiety Agent
clonidine Catapres® Antihypertensive High Blood Pressure
clopidogrel Plavix® Hematological Post Stroke/Heart Attack
cyclobenzaprine Flexeril® Skeletal Muscle Relaxant Muscle Spasm
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
26
Generic Brand Therapeutic Class Pharmaceutical Uses†
cyclobenzaprine ER Amrix® Skeletal Muscle Relaxant Muscle Spasm
desvenlafaxine ER Pristiq® Antidepressant Depression
dexlansoprazole Dexilant™ Ulcer Drug Ulcers/GERD
diazepam Valium® Antianxiety Agent Anxiety/Muscle spasms
diclofenac potassium Cataflam® NSAID Pain/Inflammation
diclofenac Voltaren® NSAID Pain/Inflammation
diclofenac Zorvolex® NSAID Pain/Inflammation
diclofenac ER Voltaren®-XR NSAID Pain/Inflammation
diclofenac gel Voltaren® Gel Topical NSAID Pain/Inflammation
diclofenac patch Flector® Patch Topical NSAID Pain/Inflammation
diclofenac potassium Zipsor® NSAID Pain/Inflammation
diclofenac solution Pennsaid® Solution Topical NSAID Pain/Inflammation
diclofenac/misoprostol Arthrotec® NSAID Pain/Inflammation
divalproex Depakote® Anticonvulsant Seizures/Migraine/Bipolar Disorder
divalproex ER Depakote® ER Anticonvulsant Seizures/Migraine/Bipolar Disorder
docusate sodium Colace® Laxative Constipation
doxepin Sinequan® Antidepressant Depression/Insomnia
doxycycline hyclate Vibramycin® Antibiotic Bacterial Infections
duloxetine Cymbalta® Antidepressant Depression/Pain/Anxiety
emtricitabine/tenofovir Truvada® Antiviral Human Immunodeficiency Virus Infection
enoxaparin Lovenox® Anticoagulant Blood Thinner
escitalopram Lexapro® Antidepressant Depression
esomeprazole magnesium Nexium® Ulcer Drug Ulcers/GERD
eszopiclone Lunesta® Hypnotic Insomnia
etodolac Lodine® NSAID Pain/Inflammation
etodolac ER Lodine® ER NSAID Pain/Inflammation
ezetimibe Zetia® Antihyperlipidemic High Cholesterol
famotidine Pepcid® Ulcer Drug Ulcers/GERD
fenofibrate Tricor® Antihyperlipidemic High Cholesterol
fentanyl Duragesic® Opioid Analgesic Pain
fluoxetine Prozac® Antidepressant Depression
fluticasone Flonase® Corticosteroid - Nasal Allergies
fluticasone/salmeterol Advair Diskus® Antiasthmatic Asthma/COPD
furosemide Lasix® Diuretic High Blood Pressure/Heart Failure
gabapentin Neurontin® Anticonvulsant Seizures/Nerve Pain
gabapentin Gralise® Anticonvulsant Nerve Pain
gabapentin enacarbil Horizant® Anticonvulsant Restless Legs Syndrome
hydrochlorothiazide Hydrodiuril® Diuretic High Blood Pressure/Heart Failure
hydrocodone ER Hysingla® ER Opioid Analgesic Pain
hydrocodone/acetaminophen Norco® Opioid Analgesic Pain
hydrocodone/ibuprofen Vicoprofen® Opioid Analgesic Pain
hydromorphone Dilaudid® Opioid Analgesic Pain
Generic-Brand Index
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
27
Generic Brand Therapeutic Class Pharmaceutical Uses†
hydromorphone ER Exalgo® Opioid Analgesic Pain
hydroxyzine Atarax® Antianxiety Agent Anxiety/Itching
hydroxyzine pamoate Vistaril® Antianxiety Agent Anxiety/Itching
ibuprofen Advil® NSAID Pain/Inflammation
ibuprofen/famotidine Duexis® NSAID/Histamine Blocker Arthritis/Ulcer Risk Reduction
indomethacin Tivorbex® NSAID Pain/Inflammation
ipratropium bromide/albuterolCombivent® Respimat® Antiasthmatic COPD
ketoprofen Orudis® NSAID Pain/Inflammation
ketorolac Toradol® NSAID Pain/Inflammation
lactulose Constulose® Laxative Constipation
lamotrigine Lamictal® Anticonvulsant Seizures/Bipolar Disorder
lansoprazole Prevacid® Ulcer Drug Ulcers/GERD
levetiracetam Keppra® Anticonvulsant Seizures
levofloxacin Levaquin® Antibiotic Bacterial Infections
levothyroxine Synthroid® Thyroid Thyroid Hormone Deficiency
lidocaine ointment Xylocaine® Dermatological - Topical Numbing/Nerve Pain
lidocaine patch Lidoderm® Patch Topical Analgesic - Anesthetic Nerve Pain
lidocaine/menthol Terocin Patch Dermatological - Topical Topical Pain Relief
linaclotide Linzess® Gastrointestinal Agent Constipation/Irritable Bowel Syndrome
lisinopril Zestril® Antihypertensive High Blood Pressure/Heart Failure
lorazepam Ativan® Antianxiety Agent Anxiety/Insomnia
losartan potassium Cozaar® Antihypertensive High Blood Pressure
lubiprostone Amitiza® Gastrointestinal Agent Constipation/Opioid-Induced Constipation
meclizine Antivert® Antiemetic Nausea/Vomiting
meloxicam Mobic® NSAID Pain/Inflammation
metaxalone Skelaxin® Skeletal Muscle Relaxant Muscle Spasm
metformin Glucophage® Antidiabetic High Blood Sugar
methadone Dolophine® Opioid Analgesic Pain
methocarbamol Robaxin® Skeletal Muscle Relaxant Muscle Spasm
methyl salicylate/ capsaicin/menthol
New Terocin Lotion Dermatological - Topical Topical Pain Relief
methylphenidate Ritalin® Stimulant Attention Deficit Hyperactivity Disorder
methylprednisolone Medrol® Corticosteroid Inflammatory Disorders
metoprolol ER Toprol-XL® Antihypertensive High Blood Pressure/Heart Failure/Angina
metoprolol tartrate Lopressor® Antihypertensive High Blood Pressure/Angina
mirtazapine Remeron® Antidepressant Depression
modafinil Provigil® Stimulant Narcolepsy/Sleep Apnea/Shift Work Disorder
montelukast Singulair® Antiasthmatic Asthma/Allergic Rhinitis
morphine ER Arymo® ER Opioid Analgesic Pain
morphine ER Avinza® Opioid Analgesic Pain
morphine ER Kadian® Opioid Analgesic Pain
morphine ER MS Contin® Opioid Analgesic Pain
Generic-Brand Index
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
28
Generic Brand Therapeutic Class Pharmaceutical Uses†
morphine/naltrexone Embeda® Opioid Analgesic Pain
mupirocin Bactroban® Antiinfective - Topical Skin Infections
nabumetone Relafen® NSAID Pain/Inflammation
naloxegol Movantik® Gastrointestinal Agent Opioid-Induced Constipation
naproxen Naprosyn® NSAID Pain/Inflammation
naproxen delayed-release EC-Naprosyn® NSAID Pain/Inflammation
naproxen sodium Anaprox® DS NSAID Pain/Inflammation
naproxen/esomeprazole Vimovo® NSAID/Proton Pump Inhibitor Arthritis/Ulcer Risk Reduction
nebivolol Bystolic® Antihypertensive High Blood Pressure
nortriptyline Pamelor® Antidepressant Depression/Insomnia/Nerve Pain
olanzapine Zyprexa® Antipsychotic Schizophrenia/Bipolar Disorder/Depression
omeprazole Prilosec® Ulcer Drug Ulcers/GERD
ondansetron Zofran® Antiemetic Nausea/Vomiting
orphenadrine Norflex® Skeletal Muscle Relaxant Muscle Spasm
oxaprozin Daypro® NSAID Pain/Inflammation
oxcarbazepine Trileptal® Anticonvulsant Seizures
oxybutynin ER Ditropan XL® Urinary Antispasmodic Overactive Bladder
oxycodone Roxicodone® Opioid Analgesic Pain
oxycodone ER OxyContin® Opioid Analgesic Pain
oxycodone/acetaminophen Percocet® Opioid Analgesic Pain
oxymorphone Opana® Opioid Analgesic Pain
pantoprazole Protonix® Ulcer Drug Ulcers/GERD
paroxetine Paxil® Antidepressant Depression
phenytoin Dilantin® Anticonvulsant Seizures
piroxicam Feldene® NSAID Pain/Inflammation
polyethylene glycol MiraLAX® Laxative Constipation
potassium chloride Klor-Con® Mineral & Electrolyte Potassium Deficiency
prazosin Minipress® Antihypertensive High Blood Pressure
prednisolone Pred Forte® Ophthalmic Eye Inflammation
prednisone Deltasone® Corticosteroid Inflammatory Disorders
pregabalin Lyrica® Anticonvulsant Fibromyalgia/Seizures/Nerve Pain
promethazine Phenergan® Antihistamine Nausea/Vomiting
propranolol Inderal® Antihypertensive High Blood Pressure/Migraine
propranolol ER Inderal® LA Antihypertensive High Blood Pressure/Migraine
quetiapine Seroquel® Antipsychotic Schizophrenia/Bipolar Disorder
quetiapine ER Seroquel XR® Antipsychotic Schizophrenia/Bipolar Disorder/Depression
rabeprazole Aciphex® Ulcer Drug Ulcers/GERD
raltegravir Isentress® Antiviral Human Immunodeficiency Virus Infection
ramipril Altace® Antihypertensive High Blood Pressure/Heart Failure
ranitidine Zantac® Ulcer Drug Ulcers/GERD
risperidone Risperdal® Antipsychotic Schizophrenia/Bipolar Disorder
rivaroxaban Xarelto® Anticoagulant Blood Thinner
Generic-Brand Index
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
29
Generic-Brand Index
Generic Brand Therapeutic Class Pharmaceutical Uses†
ropinirole Requip® Antiparkinsonian Parkinson's Disease/Restless Legs Syndrome
rosuvastatin Crestor® Antihyperlipidemic High Cholesterol
senna/docusate sodium Senokot-S® Laxative Constipation
sennosides Senokot® Laxative Constipation
sertraline Zoloft® Antidepressant Depression
sildenafil Viagra® Misc Cardiovascular Erectile Dysfunction/Pulmonary Hypertension
silver sulfadiazine Silvadene® Antiinfective - Topical Burn Wound
simvastatin Zocor® Antihyperlipidemic High Cholesterol
sulfamethoxazole/ trimethoprim
Bactrim® DS Antibiotic Bacterial Infections
sulindac Clinoril® NSAID Pain/Inflammation
sumatriptan Imitrex® Migraine Product Migraine
tadalafil Cialis® Misc Cardiovascular Erectile Dysfunction/Enlarged Prostate
tamsulosin Flomax® Misc Genitourinary Product Enlarged Prostate
tapentadol Nucynta® Opioid Analgesic Pain
tapentadol ER Nucynta® ER Opioid Analgesic Pain
temazepam Restoril™ Hypnotic Insomnia
testosterone Androgel® Androgen Testosterone Deficiency
tiotropium Spiriva® Handihaler® Antiasthmatic COPD
tizanidine Zanaflex® Skeletal Muscle Relaxant Muscle Spasm
topiramate Topamax® Anticonvulsant Seizures/Migraine
tramadol Ultram® Opioid Analgesic Pain
tramadol ER Conzip® Opioid Analgesic Pain
tramadol ER Ultram® ER Opioid Analgesic Pain
tramadol/acetaminophen Ultracet® Opioid Analgesic Pain
trazodone Desyrel® Antidepressant Depression/Insomnia
triamcinolone Kenalog® Corticosteroid - Topical Inflammatory Disorders
valsartan Diovan® Antihypertensive High Blood Pressure/Heart Failure
venlafaxine Effexor® Antidepressant Depression
venlafaxine ER Effexor® XR Antidepressant Depression
vilazodone Viibryd® Antidepressant Depression
vortioxetine Trintellix® Antidepressant Depression
warfarin Coumadin® Anticoagulant Blood Thinner
zolpidem Ambien® Hypnotic Insomnia
zolpidem ER Ambien CR® Hypnotic Insomnia
zonisamide Zonegran® Anticonvulsant Seizures
DISCLAIMERS: The information is provided AS IS, for informational purposes only, and is not intended to constitute medical advice or to be used for diagnostic or treatment purposes. Optum does not warrant or guarantee the accuracy of this information and is not responsible for any results obtained from its use. Contact a physician or other health care provider before taking any medical action based on this information, including changes to medication therapy. Readers are encouraged to confirm information independently and/or consult with their legal representatives.NOTE: Company and product names mentioned are either registered trademarks or trademarks of their respective users. Some brand name products are no longer on the market. Furthermore, if a generic medication is commercially available, not all strengths may have a generic equivalent.
† Pharmaceutical uses listed are not all-inclusive; does not include all FDA approved and off-label uses. ER, XR, CR, LA, XL = Extended-release formulations RED = Generic not available NSAID = Nonsteroidal Anti-inflammatory Drug COPD = Chronic Obstructive Pulmonary Disease GERD = Gastroesophageal Reflux Disease
30
Drug overdoses are now responsible for more deaths than car accidents.We commonly see estimates of around 4.5 million people suffering from opioid analgesic abuse, recent estimates indicate more than 5 million Americans suffer from prescription pain killer addictions.
Five opioid risk management strategies1. Prevention and education2. Minimizing early exposure3. Reducing inappropriate supply4. Treating the at-risk and high-risk5. Supporting chronic populations and those in recovery
Nationwide, opioid analgesic abuse costs employers an estimated
$25.5 billion a year in missed workdays
and lost productivity.
3,900people initiate non-medical use of opioid analgesics
580people initiate heroin use
78people die from an opioid-related overdose
650,000opioid analgesic prescriptions are dispensed
More than
Drug overdose is the leading cause of accidental death in the US, with
lethal drug overdoses in 2015.
Opioid analgesic addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers, and 12,990 overdose deaths related to heroin in 2015.
52,404
The 2013 and 2014 National Survey on Drug Use and Health (NSDUH) found that
of people misusing prescription painkillers got them from a friend or relative for free.
50.5%
It is estimated between
and between
of claimants with chronic pain end up misusing medications
become addicted to them
21% and 29%
8% and 12%
people are treated in emergency departments for not using opioid analgesics as directed.
Each day more than
1,000
25 to 54Overdose rates were highest among people aged
of all workers’ compensation costs
are related to opioid analgesics25%
of patients who survive overdose
are prescribed more opioid analgesics91%
dispensed in the world are dispensed in the U.S.
of all opioid analgesics80%
12% declinein opioid analgesic prescriptions, after a peak in 2012.
For the first time, 2016 saw a
On an average day in the U.S.
31
2017. Available at: https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf. Accessed August 17, 2017.
LiveScience Facts About Opioids — Hydrocodone, Oxycodone, Codeine & Others. Live Science. 2017. Available at: https://www.livescience.com/53856-opioid-facts.html. Accessed August 17, 2017.
Steven A. King M. 10 Opioid Myths and Facts | Psychiatric Times. Psychiatrictimes.com. December 16, 2016. Available at: http://www.psychiatrictimes.com/special-report/10-opioid-myths-and-facts. Accessed August 17, 2017.
Annual Review of Public Health. The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction. Vol. 36: 559-574 (March 2015). Accessed at: http://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031914-122957 on September 28, 2016.
Opioid Factsheet. HHS.gov US Department of Health & Human Services. 2017. Available at: https://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf. Accessed August 17, 2017.
Goodnough, A., & Tavernise, S. (2016, May 20). Opioid Prescriptions Drop for First Time in Two Decades. New York Times. Retrieved February 24, 2017, from https://www.nytimes.com/2016/05/21/health/opioid-prescriptions-drop-for-first-time-in-two-decades.html
Mole, Beth. “91% of patients who survive opioid overdose are prescribed more opioids.” Ar Technica
Prescription Opioid Overdose Data | Drug Overdose | CDC Injury Center. Cdcgov. 2017. Available at: https://www.cdc.gov/drugoverdose/data/overdose.html. Accessed August 17, 2017.
Meinert, D. (2016, March 1). Combatting the Prescription Drug Crisis. HR Today.
Sources
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