Analgesics
Analgesics, Narcotic

Brand/Generic Name
(Generics in italics)		 Dosage/Strength Status Restrictions Notes Copayment
Tier
Pentazocine-APAP generic.gif (400 bytes)
Pentazocine-APAP		   approved.gif (510 bytes)

ql.gif

  Tier 1
Talacen
Pentazocine-APAP		   nonform.gif (510 bytes)   NOTES.gif (377 bytes) N/A

Key for Product(s) Listed Above
Formulary
Non-Formulary
Prior Authorization
 Not Reimbursed
Quantity Limit
Generic is Formulary, Brand is Non-Formulary
 Step Therapy Notes
Specialty Medications
Tier 1Generic Drugs
Tier 2Selected Brand-Name Drugs Without a Generic Equivalent
Tier 3Specialty Drugs

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