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Author: Admin | 2025-04-28
10-325 MG 180 Tablets 30 DAYS Endocet ; Percocet Oxycodone w/ Acetaminophen Tab 2.5-325 MG 2.5-325 MG 360 Tablets 30 DAYS Endocet ; Percocet Oxycodone w/ Acetaminophen Tab 5-325 MG 5-325 MG 360 Tablets 30 DAYS Endocet ; Percocet Oxycodone w/ Acetaminophen Tab 7.5-325 MG 7.5-325 MG 240 Tablets 30 DAYS Fioricet/codeine Butalbital-Acetaminophen-Caff w/ COD Cap 50-300-40-30 MG 50-300-40-30 MG 180 Capsules 30 DAYS Lortab Hydrocodone-Acetaminophen Soln 10-300 MG/15ML 10-300 MG/15ML 2025 mLs 30 DAYS Methadone hydrochloride i ; Methadose ; Methadose sugar-free Methadone HCl Conc 10 MG/ML 10 MG/ML ; 5 MG/0.5ML 90 mLs 30 DAYS Methadose Methadone HCl Tab For Oral Susp 40 MG 40 MG 90 Tablets 30 DAYS Nalocet Oxycodone w/ Acetaminophen Tab 2.5-300 MG 2.5-300 MG 360 Tablets 30 DAYS Nucynta Tapentadol HCl Tab 100 MG 100 MG 180 Tablets 30 DAYS Nucynta Tapentadol HCl Tab 50 MG 50 MG 180 Tablets 30 DAYS Nucynta Tapentadol HCl Tab 75 MG 75 MG 180 Tablets 30 DAYS Oxaydo Oxycodone HCl Tab 7.5 MG 180 Tablets 30 DAYS Oxaydo Oxycodone HCl Tab 5 MG 5 MG 360 Tablets 30 DAYS Prolate Oxycodone w/ Acetaminophen Soln 10-300 MG/5ML 900 mLs 30 DAYS Prolate Oxycodone w/ Acetaminophen Tab 10-300 MG 10-300 MG 180 Tablets 30 DAYS Prolate Oxycodone w/ Acetaminophen Tab 5-300 MG 5-300 MG 360 Tablets 30 DAYS Prolate Oxycodone w/ Acetaminophen Tab 7.5-300 MG 7.5-300 MG 240 Tablets 30 DAYS Qdolo Tramadol HCl Oral Soln 5 MG/ML 2400 mLs 30 DAYS Roxicodone Oxycodone HCl Tab 15 MG 15 MG 180 Tablets 30 DAYS Roxicodone Oxycodone HCl Tab 30 MG 30 MG 180 Tablets 30 DAYS Roxybond Oxycodone HCl Tab Abuse Deter 5 MG 360 Tablets 30 DAYS Roxybond Oxycodone HCl Tab Abuse Deter 15 MG 180 Tablets 30 DAYS Roxybond Oxycodone HCl Tab Abuse Deter 30 MG 180 Tablets 30 DAYS Seglentis Celecoxib-Tramadol HCl Tab 56-44 MG 120 Tablets 30 DAYS Trezix Acetaminophen-Caffeine-Dihydrocodeine Cap 320.5-30-16 MG 320.5-30-16 MG 300 Capsules 30 DAYS Ultracet Tramadol-Acetaminophen Tab 37.5-325 MG 37.5-325 MG 240 Tablets 30 DAYS Xodol Hydrocodone-Acetaminophen Tab 5-300 MG 5-300 MG 240 Tablets 30 DAYS CLIENT SUMMARY – QUANTITY LIMITS Target Brand Agent Name(s) Target Generic Agent Name(s) Strength Client Formulary Acetaminophen w/ Codeine Soln 120-12 MG/5ML 120-12 MG/5ML Blue Partner ; Commercial ; GenPlus ; Health Insurance Marketplace ; NetResults A Series ; SourceRx Acetaminophen w/ Codeine Tab 300-15 MG 300-15 MG Blue Partner ; Commercial ;
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