POLICY: Medicare Part D Formulary-Level Cumulative Opioid and Opioid/Buprenorphine POS Edits MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111 Policy for contracts H3351, S3521 and H3335 P&T Committee Approval Date: 3/1/2018 Page 1 of 21 Original Effective Date: 01/01/2017 Current Effective Date: 3/1/2018 Revision Date: 1/1/2019 Sponsor Name & Title: Darlene Rocco, Director Pharmacy Management Signature: Approval Name & Title: Mona Chitre Vice President Pharmacy Management Signature: In the CMS Final Call Letter for CY2017, CMS outlined the expectation of Plan Sponsors to implement the following POS edits beginning 1/1/2017: Formulary-level hard or soft cumulative opioid POS edit Soft edit requirements: 90mg-120mgMED (morphine-equivalent dosing that can be overridden by the pharmacist using appropriate NCPDP codes Hard edit requirements: 200mg MED that cannot be overridden by the pharmacist using a NCPDP code Plans may incorporate a provider or pharmacy count in the edit. CMS recommends a minimum threshold of two prescribers if this functionality utilized. Individual quantity limits for opioids were not submitted to CMS for CY2017 in order to minimize the confusion with the MED requirement. Soft edit for concurrent use of opioids and buprenorphine. Soft edit triggers when an opioid prescription is presented following the initiation of buprenorphine for the treatment of opioid-use disorder. This is a soft edit that can be overridden by the pharmacist using appropriate NCPDP codes. 12 The Health Plan has experience with this methodology on the commercial/medicaid/exchange lines of business. PBM support: ESI participated in the 2015 pilot project intended to evaluate the feasibility and impact of the proposed POS edits ESI applied the formulary-level opioid requirement using the hard opioid POS edit for CY2017. ESI applied the soft edit requirement for concurrent opioids/buprenorphine for CY2017. A prescriber bypass list was also implemented for 1/1/2017 to prevent inappropriate rejections for members in hospice or palliative care or who have a cancer diagnosis. The prescription adjudication system reviews medical and prescription claims history to identify drugs or ICD-10 codes reflective of a cancer diagnosis. If a cancer drug or diagnosis found, the claim will pay without intervention. 1
Formulary-level opioid review criteria: All opioids (other than buprenorphine SL), included in OPIOID DRUGS INCLUDED IN POS EDIT CHART on page 3: 1. Is patient enrolled in a hospice program? a. If yes, submit to Medicare Part A. Refer to the Medicare D-Hospice DLP (DLP009). b. If no, continue with the criteria below 2. Patient has been diagnosed with cancer and appropriate pain management requires dosing that exceeds the restricted amount. Authorize a quantity limit override for 12 months. 3. Patient has a terminal illness and appropriate pain management requires dosing that exceeds the restricted amount. Authorize a quantity limit override for 12 months. 4. The prescriber states based on the patient s clinical circumstances that the amount of opioid prescribed is warranted in order to adequately manage the patient s pain. Authorize a quantity limit override for 12 months. For Buprenorphine Sublingual ONLY, included in OPIOID DRUGS INCLUDED IN POS EDIT CHART on page 3: 1. Buprenorphine SL is being used as maintenance opioid dependency. Authorize a quantity limit override for 12 months. Note: Belbuca is only indicated for pain management, not opioid dependency. 2. Is patient being enrolled in a hospice program? a. If yes, submit to Medicare Part A. Refer to the Medicare D-Hospice DLP (DLP009). b. If no, continue with the criteria below 3. Patient has been diagnosed with cancer and appropriate pain management requires dosing that exceeds the restricted amount. Authorize a quantity limit override for 12 months. 4. Patient has a terminal illness and appropriate pain management requires dosing that exceeds the restricted amount. Authorize a quantity limit override for 12 months. 5. The prescriber states based on the patient s clinical circumstances that the amount of opioid prescribed is warranted in order to adequately manage the patient s pain. Authorize a quantity limit override for 12 months. Background: The Centers for Medicare & Medicaid Services (CMS) published a pilot study in the September 6, 2012 memo Supplemental Guidance related to Improving Drug Utilization Review Controls in Part D in which they identified a methodology for establishing a threshold for high use of opioids based on morphine equivalent dose (MED). 1 This pilot study was conducted in the context of establishing a targeted population for reducing fraud, waste and abuse for opioids in the Medicare Part D program. Each opioid claim was converted to a daily oral morphine equivalent dose (MED) using the corresponding MED conversion factor based on the Consortium to Study Opioid Risks and Therapeutics (CONSORT) classification of opioid medications and morphine equivalent conversion factors per milligram of opioid. CMS believes the use of daily 120 mg MED (MED 120) calculations as a screening tool may help identify beneficiaries who are at risk for potential adverse effects or possible inappropriate use or diversion of opioids. 1 To identify beneficiaries with prescription opioids that exceeded the MED threshold, each claim is converted into the MED with the appropriate conversion factor (Table 1) associated with the opioid product of that prescription claim. 1 CMS determined a threshold MED of 120 mg/day as a result of a study that showed 100 mg or more per day MED had a 9-fold increase in overdose risk. Most overdoses were medically serious, and 12% were fatal. 1 Based on an analysis of ESI s Medicare prescription data, a cumulative threshold MED of 200 mg/day was determined to meet the intent of the QL with consideration to member impact. CMS published a table from the CONSORT trial that provided conversion factors per mg of opioid in the September 2012 supplemental guide for oral opioids. 1,5 In July 2013, the CDC published a new list of opiates conversions that included newer opiates, injectables and suppositories. Table 1 contains conversion factors for opiates for the dosage form listed to oral morphine as determined from CMS, the CDC list, additional personal communication with the CDC (Chris Jones, CDC, October 21, 2013) and the literature. 2
OPIOID DRUGS INCLUDED IN POS EDIT: BUPRENORPHINE TRANSDERMAL BUPRENORPHINE INJECTION BUPRENORPHINE SUBLINGUAL (TABLET AND FILM) BUTORPHANOL INJECTION BUTORPHANOL NASAL SOLUTION CODEINE PHOSPHATE INJECTION CODEINE SULFATE TABLETS CAPSULES AND SOLUTION DIHYDROCODEINE TABLETS, CAPSULES AND SOLUTION FENTANYL CITRATE TRANSMUCOSAL LOZENGES FENTANYL CITRATE BUCCAL TABLETS FENTANYL CITRATE NASAL SOLUTION FENTANYL CITRATE SUBLINGUAL SPRAY FENTANYL CITRATE SUBLINGUAL TABLET FENTANYL INJECTION FENTANYL TRANSDERMAL PATCHES TABLETS AND SOLUTION HYDROMORPHONE INJECTION HYDROMORPHONE TABLETS AND SOLUTION HYDROMORPHONE RECTAL LEVORPHANOL MEPERIDINE TABLETS, AND SOLUTION MEPERIDINE INJECTION METHADONE INJECTION METHADONE TABLETS AND SOLUTION TABLETS, CAPSULES AND SOLUTION INJECTION RECTAL NALBUPHINE INJECTION TABLETS, CAPSULES AND SOLUTION OXYMORPHONE TABLETS PENTAZOCINE INJECTION PENTAZOCINE CONTAINING TABLETS TAPENTADOL TABLETS TRAMADOL TABLETS, CAPSULES AND SOLUTION /NALOXONE EXTENDED RELEASE TABLETS 3
Table 1 Morphine equivalent conversion factors per milligram of opioid 1 OPIATE ROUTE OF ADMINISTR ATION EQUIVALENT CONVERSION FACTOR PER MG OF OPIOID Buprenorphine Transdermal 12.6 ( converting from mcg/hr for 7 days) See Table 3 Buprenorphine Injection 75 2,8 Buprenorphine± film SL/Buccal 10-75± (CMS recommends 10) Butorphanol* Injection 15 9,11 Butorphanol nasal solution* Nasal 15 9,11 Codeine phosphate Injection 0.25 7-9 Codeine sulfate Oral 0.15 1,5,6 Dihydrocodeine Oral 0.25 1,5,6 Fentanyl citrate lozenge (Actiq,generics) Transmucos al 130 4 Fentanyl citrate (Fentora) Buccal Tab 130 4 Fentanyl nasal solution (Lazanda) Nasal 160 4 Fentanyl spray (Subsys) SL 180 4 Fentanyl tablet (Abstral) SL 130 4 Fentanyl Injection 300 6-9 Fentanyl Transdermal 100 (or 7.2 when converting from mcg/hr for 3 days) See Table 2 Hydrocodone Oral 1 1,5,6 Hydromorphone Injection 20 6-9 Hydromorphone Oral 4 1 Hydromorphone Rectal 4 2 Levorphanol Oral 11 1 Meperidine Injection 0.3 6-9 Meperidine Oral 0.1 1 Methadone:^ > 0 to 20 mg daily dose Methadone:^ > 20 to 40 mg daily dose Oral, Injection Oral, Injection 4 REF 3 2,3,4 1,4 4 11 8 11
OPIATE Methadone:^ > 40 to 60 mg daily dose Methadone:^ > 60 mg daily dose ROUTE OF ADMINISTR ATION Oral, Injection Oral, Injection EQUIVALENT CONVERSION FACTOR PER MG OF OPIOID REF 10 11 12 11 Morphine Injection 3 2 Morphine Oral 1 1,4 Morphine Rectal 1 2 Nalbuphine Injection 3 8 Oxycodone HCL Oral 1.5 1 Oxycodone (Xtampza Oral 1.67 # Oxymorphone injection 30 6-9 Oxymorphone Oral 3 1 Pentazocine Injection 0.37 3,4 Pentazocine /acetaminophen Oral 0.37 3,4 Tapentadol Oral 0.4 2,3,9 Tramadol Oral 0.1 3,4 ± CDC confirmation requested 11_15_13 * based on product labeling, differs from CDC recommendation of 7 all injection routes (IV/IM/SC/epidural) per CMS Medication list 10-31-2013 #conversion factor based on oxycodone equivalent per mg Xtampza ER product. ^ The CDC MME conversion factor to calculate morphine milligram equivalents is 3. CMS uses this conversion factor when analyzing Medicare population opioid use. CMS uses the graduated methadone MME conversion factor to calculate MME within the Overutilization Monitoring System (OMS) for identifying and reporting potential opioid overutilizers. 5
METHOD FOR CALCULATION OF THE CUMULATIVE DAILY EQUIVALENT DOSE (MED) The cumulative daily MED correlates with the risk of dose-related morbidity and mortality. The general algorithm used to determine the daily MED is as follows: 1. # of Opioid Dosage units per day is calculated as follows= (Opioid claim quantity) (Opioid claim days supply) 2. Oral MED Daily Dose per claim = (# Opioid Dosage Units per day) X (#mg Opioid per dosage unit) X (MED conversion factor) 3. Cumulative MED: Oral MED daily dose per claim for all opiates received A MED is calculated for each members opioid prescription claim using the appropriate conversion factor associated with the opioid product for the claim. After converting the member s opioid medications to their MED, a beneficiary s cumulative prescription opioid daily dose (MED) is calculated using the above algorithm to determine if he/she exceeded the 200 MED threshold. A prescription will reject at POS that, if filled, would cause the member to exceed the cumulative daily MED threshold of 200. The Center for Disease Control and Prevention (CDC) Morphine Milligram Equivalent Table, released in May 2014, specifically excludes all opioid cough and cold products from the calculations of MED. CMS states that testing confirms that the removal of these products does not significantly impact the identification of potential opioid overutilization. 3 Table 4 contains product specific quantity level limits-meqd 200 per 30 days for the individual chemical entity. The QL in Table 4 would equal the member s cumulative quantity level limits-meqd 200 per 30 days only if the member was not receiving multiple opioid prescriptions. TRANSDERMAL FENTANYL AND BUPRENORPHINE MED CONVERSION Typically, patients will be prescribed a Fentanyl or Buprenorphine patch for use every three (3) or seven (7) days, respectively. However, the timeframe for a patch may vary depending upon the doctor s instructions. Therefore, even though the duration of use of each patch may be prescribed for less than the typical number of days, the quantity of medication a patient receives each day remains constant. Table 2 contains the mg opioid per dosage unit, the MED conversion factor, the approximate MED, MEqD 200 30 day and 90 day QL for transdermal fentanyl and Table 3 contains the same information for transdermal buprenorphine. Buprenorphine and fentanyl transdermal patches are expected to remain in place for 7 and 3 days, respectively, which is taken into account when calculating the MEqD 200 30 day QL. Table 2: Transdermal Fentanyl MED conversion Dose Mg Opioid/ Dosage Unit for 3 days (FROM CMS) MED Conversion Factor (CMS) MED conversion Mcg/hr (CDC) MED MEqD 200 30 day QL (Patche s) MEqD 200 90 day QL (Patches) 12 mcg/hr 0.864 100 7.2 28.8 69 209 25 mcg/hr 1.8 100 7.2 60 34 100 37.5 mcg/hr 2.64 100 7.2 81 25 74 50 mcg/hr 3.6 100 7.2 120 17 50 62.5 mcg/hr 4.5 100 7.2 135 15 45 75 mcg/hr 5.4 100 7.2 180 12 34 87.5 mcg/hr 6.3 100 7.2 189 11 32 100 mcg/hr 7.2 100 7.2 240 9 25 For example, the MED calculated for a prescription written for Fentanyl 25 mcg/hr #10 patches for a 30-day supply would be calculated as follows: # opioid dosage units per day= 1/3 or 0.3333333333 Oral MED (CDC)= 0.333333333 X 7.2 X 25= 60 6
Table 3: Transdermal Buprenorphine MED conversion Dosage Form Mg Opioid/ Dosage Unit (for 7 days) MG Opioid per day MED Conversion Factor (from CDC accounting for mcg/hr Q7 day use) 3 Approximate MED based on CDC conversion factor MEqD 200 30 day QLL based on CDC conversion factor (Patches) 5 mcg/hr 0.84 0.12 12.6 9 89 7.5 mcg/hr 1.26 0.18 12.6 14 75 10 mcg/hr 1.68 0.24 12.6 18 45 15 mcg/hr 2.52 0.36 12.6 27 30 20 mcg/hr 3.36 0.48 12.6 36 23 For example, the MED calculated for a prescription written for Butrans 10 mcg/hr #4 for a 28-30 day supply would be calculated as follows: a. # opioid dosage units per day= 1/7 or 0.142 b. Oral MED= 10 X 12.6 X 0.142=18 c. 200/18 *4=45 (rounded) The CDC supplied a conversion factor for buprenorphine of 42 and then clarified the conversion factor to 12.6 in a subsequent communication to the plan sponsors (July 11, 2014). This conversion factor is very conservative compared with other sources citing a conversion of 70-100, thus the MEqD 200 30 day QL is higher than most patients would be expected to receive. 2,3 MEqD 200 is rounded up to the nearest whole number for the patches. The Prescription Drug Monitoring Program (PDMP), US Department of Justice, published the following regarding MEqD calculations with claims data for transdermal fentanyl and buprenorphine: 10 Fentanyl and Buprenorphine patches are two (2) important exceptions to using the CMS formula to compute MMEs. The exception only applies to the Fentanyl and Buprenorphine patches; not the other dosage forms of either medication. Consequently, a standard has been established to account for possible variances in the length of time a patch is worn. The standard is based on the length of time a patient would normally be using the patch: three (3) days for Fentanyl and seven (7) days for Buprenorphine. In order for the formula to work properly and compute the MME accurately, the Days Supply value should be changed to equal three (3) times the quantity for Fentanyl patches and seven (7) times the quantity for Buprenorphine patches; regardless of the Days Supply value written on the prescription. EXAMPLE: 10 Fentanyl patches are prescribed for twenty (20) days. Since a Fentanyl patch is typically used for three (3) days, the Days Supply value should be thirty (30) for computing the MME. (drug strength)*(drug quantity)*(mme Conversion factor) (days supply) 7
OPIOID PRODUCT NAME ROUTE DOSAGE FORM 8 DOSAGE Unit STRENGTH (MG OPIOID PER DOSAGE UNIT) STRENGTH UNIT MME CONVERSION FACTOR (CF) MED 200 CALCULATION (200/[CF X MG]) X 30 PRODUCT- SPECIFIC, NON- CUMULATIVE CODEINE ACETAMINOPHEN / BUTALBITAL / CAFFEINE CAPSULE CA 30 MG 0.15 1333.333333 / CODEINE PHOSPHATE DIHYDROCODEINE ACETAMINOPHEN / CAFFEINE / CAPSULE CA 16 MG 0.25 1500 DIHYDROCODEINE BITARTRATE DIHYDROCODEINE ACETAMINOPHEN / CAFFEINE / TABLET EA 32 MG 0.25 750 DIHYDROCODEINE BITARTRATE CODEINE ACETAMINOPHEN / CODEINE PHOSPHATE SUSPENSION ML 2.4 MG/ML 0.15 16666.66667 CODEINE ACETAMINOPHEN / CODEINE PHOSPHATE TABLET EA 15 MG 0.15 2666.666667 CODEINE ACETAMINOPHEN / CODEINE PHOSPHATE TABLET TA 30 MG 0.15 1333.333333 CODEINE ACETAMINOPHEN / CODEINE PHOSPHATE TABLET TA 60 MG 0.15 666.6666667 ACETAMINOPHEN / BITARTRATE SOLUTION, ML 0.5 MG/ML 1 12000 ACETAMINOPHEN / SOLUTION ML 0.666666667 MG/ML 1 8999.999996 BITARTRATE ACETAMINOPHEN / TABLET EA 2.5 MG 1 2400 BITARTRATE ACETAMINOPHEN / TABLET TA 5 MG 1 1200 BITARTRATE ACETAMINOPHEN / TABLET TA 7.5 MG 1 800 BITARTRATE ACETAMINOPHEN / TABLET TA 10 MG 1 600 BITARTRATE ACETAMINOPHEN / SOLUTION ML 1 MG/ML 1.5 4000 HYDROCHLORIDE ACETAMINOPHEN / TABLET TA 2.5 MG 1.5 1600 HYDROCHLORIDE ACETAMINOPHEN / TABLET TA 5 MG 1.5 800 HYDROCHLORIDE ACETAMINOPHEN / TABLET TA 7.5 MG 1.5 533.3333333 HYDROCHLORIDE ACETAMINOPHEN / EXTENDED RELEASE TA 7.5 MG 1.5 533.3333333 HYDROCHLORIDE EXTENDED RELEASE TABLETS (XARTEMIS) (BIPHASIC RELEASE) TABLET ACETAMINOPHEN / TABLET TA 10 MG 1.5 400 HYDROCHLORIDE PENTAZOCINE ACETAMINOPHEN / PENTAZOCINE TABLET TA 25 MG 0.37 648.6486486 HYDROCHLORIDE TRAMADOL ACETAMINOPHEN / TRAMADOL TABLET TA 37.5 MG 0.1 1600 HYDROCHLORIDE CODEINE ASPIRIN / BUTALBITAL / CAFFEINE / CAPSULE CA 30 MG 0.15 1333.333333 CODEINE PHOSPHATE DIHYDROCODEINE ASPIRIN / CAFFEINE / DIHYDROCODEINE CAPSULE CA 16 MG 0.25 1500 BITARTRATE ASPIRIN/CARISOPRODOL/CODEINE TABLET TA 16 MG 0.15 2500 ASPIRIN / HYDROCHLORIDE TABLET EA 4.835 MG 1.5 827.3009307
BUPRENORPHINE BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY (EXPECTED TO REMAIN IN PLACE FOR 7 DAYS) BUPRENORPHINE BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY (EXPECTED TO REMAIN IN PLACE FOR 7 DAYS) BUPRENORPHINE BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY (EXPECTED TO REMAIN IN PLACE FOR 7 DAYS) BUPRENORPHINE BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY (EXPECTED TO REMAIN IN PLACE FOR 7 DAYS) BUPRENORPHINE BUPRENORPHINE TRANSDERMAL PATCH, TRANSDERMAL WEEKLY (EXPECTED TO REMAIN IN PLACE FOR 7 DAYS) TD 5 MCG/HR 12.6 89.42544154 TD 7.5 MCG/HR 12.6 59.61696103 TD 10 MCG/HR 12.6 44.71272077 TD 15 MCG/HR 12.6 29.80848051 TD 20 MCG/HR 12.6 22.35636038 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 75 MCG 30 2666.666667 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 150 MCG 30 1333.333333 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 300 MCG 30 666.6666667 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 450 MCG 30 444.4444444 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 600 MCG 30 333.3333333 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 750 MCG 30 266.6666667 BUPRENORPHINE BUPRENORPHINE HYDROCHLORIDE SUBLINGUAL FILM TABLET, SUBLINGUAL TA 900 MCG 30 222.2222222 BUPRENORPHINE BUPRENORPHINE INJECTION SYRINGE ML 0.3 MG/ML 75 266.6666667 BUPRENORPHINE BUPRENORPHINE INJECTION AMPULE ML 0.3 MG/ML 75 266.6666667 BUTORPHANOL BUTORPHANOL TARTRATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) BUTORPHANOL BUTORPHANOL TARTRATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) ML 1 MG/ML 7 857.1428571 ML 2 MG/ML 7 428.5714286 BUTORPHANOL BUTORPHANOL TARTRATE NASAL SOLUTION ML 10 MG/ML 7 85.71428571 CODEINE CODEINE SULFATE SOLUTION, ML 6 MG/ML 0.15 6666.666667 CODEINE CODEINE SULFATE TABLET EA 15 MG 0.15 2666.666667 CODEINE CODEINE SULFATE TABLET EA 30 MG 0.15 1333.333333 CODEINE CODEINE SULFATE TABLET TA 60 MG 0.15 666.6666667 CODEINE CODEINE PHOSPHATE INJECTION SOLUTION ML 15 MG/ML 0.15 2666.666667 CODEINE CODEINE PHOSPHATE INJECTION SOLUTION ML 30 MG/ML 0.15 1333.333333 FENTANYL FENTANYL INJECTION SOLUTION ML 0.05 MG/ML 300 400 9
FENTANYL FENTANYL INJECTION SOLUTION ML 0.01 MG/ML 300 2000 FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS FENTANYL FENTANYL TRANSDERMAL PATCH, TRANSDERMAL 72 HOURS TD 12 MCG/HR 7.2 69.44444444 TD 25 MCG/HR 7.2 33.33333333 TD 37.5 MCG/HR 7.2 22.22222222 TD 50 MCG/HR 7.2 16.66666667 TD 62.5 MCG/HR 7.2 13.33333333 TD 75 MCG/HR 7.2 11.11111111 TD 87.5 MCG/HR 7.2 9.523809524 TD 100 MCG/HR 7.2 8.333333333 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 100 MCG 0.18 333.3333333 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 200 MCG 0.18 166.6666667 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 400 MCG 0.18 83.33333333 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 600 MCG 0.18 55.55555556 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 800 MCG 0.18 41.66666667 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 1200 MCG 0.18 27.77777778 FENTANYL FENTANYL (SUBSYS) SUBLINGUAL LIQUID EA 1600 MCG 0.18 20.83333333 FENTANYL FENTANYL CITRATE (LAZANDA) NASAL SOLUTION EA 100 MCG 0.16 375 FENTANYL FENTANYL CITRATE (LAZANDA) NASAL SOLUTION EA 300 MCG 0.16 125 FENTANYL FENTANYL CITRATE (LAZANDA) NASAL SOLUTION EA 400 MCG 0.16 93.75 FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 100 MCG 0.13 461.5384615 FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 200 MCG 0.13 230.7692308 FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 300 MCG 0.13 153.8461538 FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 400 MCG 0.13 115.3846154 10
FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 600 MCG 0.13 76.92307692 FENTANYL FENTANYL CITRATE (FENTORA) BUCCAL TABLET, EFFERVESCENT TA 800 MCG 0.13 57.69230769 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 100 MCG 0.13 461.5384615 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 200 MCG 0.13 230.7692308 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 300 MCG 0.13 153.8461538 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 400 MCG 0.13 115.3846154 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 600 MCG 0.13 76.92307692 FENTANYL FENTANYL CITRATE (ABSTRAL) SUBLINGUAL TABLET SUBLINGUAL EA 800 MCG 0.13 57.69230769 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 200 MCG 0.13 230.7692308 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 400 MCG 0.13 115.3846154 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 600 MCG 0.13 76.92307692 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 800 MCG 0.13 57.69230769 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 1200 MCG 0.13 38.46153846 FENTANYL FENTANYL CITRATE (ACTIQ, GENERICS) BUCCAL LOZENGE ON A HANDLE EA 1600 MCG 0.13 28.84615385 BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (ZOHYDRO) BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA BITARTRATE EXTENDED RELEASE (HYSINGLA TABLET EA 10 MG 1 600 TABLET EA 15 MG 1 400 TABLET EA 20 MG 1 300 TABLET EA 30 MG 1 200 TABLET EA 40 MG 1 150 TABLET EA 50 MG 1 120 TABLET EA 100 MG 1 60 TABLET EA 120 MG 1 50 TABLET EA 20 MG 1 300 TABLET EA 30 MG 1 200 TABLET EA 40 MG 1 150 TABLET EA 60 MG 1 100 TABLET EA 80 MG 1 75 11
/ IBUPROFEN TABLET TA 2.5 MG 1 2400 / IBUPROFEN TABLET TA 5 MG 1 1200 / IBUPROFEN TABLET TA 7.5 MG 1 800 / IBUPROFEN TABLET TA 10 MG 1 600 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE INJECTION SOLUTION ML 1 MG/ML 20 300 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE TABLET TA 2 MG 4 750 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE LIQUID ML 1 MG/ML 4 1500 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE INJECTION SOLUTION AND AMPULE ML 2 MG/ML 20 150 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE RECTAL SUPPOSITORY EA 3 MG 20 100 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE TABLET TA 4 MG 4 375 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE TABLET TA 8 MG 4 187.5 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE INJECTION SOLUTION AND AMPULE ML 4 MG/ML 20 75 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE INJECTION SOLUTION ML 10 MG/ML 20 30 HYDROMORPHONE HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE (EXALGO, GENERIC) HYDROMORPHONE HYDROCHLORIDE (EXALGO, GENERIC) TABLET, EXTENDED RELEASE 24 HR TABLET, EXTENDED RELEASE 24 HR TA 8 MG 4 187.5 TA 12 MG 4 125 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 16 MG 4 93.75 (EXALGO, GENERIC) 24 HR HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE TABLET EXTENDED RELEASE EA 32 MG 4 46.875 (EXALGO, GENERIC) 24 HR HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE / EPIDURAL PLASTIC BAG, INJECTION (ML) ML 0.02 MG/ML 20 15000 BUPIVACAINE HYDROCHLORIDE IN 0.9% SODIUM CHLORIDE / PF HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE / PF INJECTION AMPULE ML 1 MG/ML 20 300 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE / PF INJECTION AMPULE ML 2 MG/ML 20 150 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE / PF INJECTION AMPULE ML 4 MG/ML 20 75 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE / PF INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 INTRAVENOUS PATIENT CONTROLLED % SODIUM CHLORIDE ANALGESIA VIAL HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE ML 10 MG/ML 20 30 ML 0.1 MG/ML 20 3000 INTRAVENOUS PREFILLED PUMP RESERVOIR ML 0.2 MG/ML 20 1500 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL ML 0.4 MG/ML 20 750 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL ML 0.5 MG/ML 20 600 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL ML 0.6 MG/ML 20 500 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INJECTION PLASTIC BAG, INJECTION (ML) ML 1 MG/ML 20 300 12
HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL ML 1.2 MG/ML 20 250 HYDROMORPHONE HYDROMORPHONE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PATIENT CONTROLLED ANALGESIA VIAL ML 2 MG/ML 20 150 IBUPROFEN / TABLET EA 5 MG 1.5 800 HYDROCHLORIDE LEVORPHANOL LEVORPHANOL TARTRATE TABLET TA 2 MG 11 272.7272727 MEPERIDINE MEPERIDINE HYDROCHLORIDE SOLUTION, ML 10 MG/ML 0.1 6000 MEPERIDINE MEPERIDINE HYDROCHLORIDE INJECTION SOLUTION ML 25 MG/ML 0.3 800 MEPERIDINE MEPERIDINE HYDROCHLORIDE TABLET TA 50 MG 0.1 1200 MEPERIDINE MEPERIDINE HYDROCHLORIDE INJECTION SOLUTION ML 50 MG/ML 0.3 400 MEPERIDINE MEPERIDINE HYDROCHLORIDE INJECTION VIAL ML 50 MG/ML 0.3 400 MEPERIDINE MEPERIDINE HYDROCHLORIDE INJECTION SOLUTION ML 75 MG/ML 0.3 266.6666667 MEPERIDINE MEPERIDINE HYDROCHLORIDE TABLET TA 100 MG 0.1 600 MEPERIDINE MEPERIDINE HYDROCHLORIDE INJECTION SOLUTION ML 100 MG/ML 0.3 200 MEPERIDINE MEPERIDINE HYDROCHLORIDE / PF INJECTION DISPOSABLE SYRINGE (ML) ML 50 MG/ML 0.3 400 MEPERIDINE MEPERIDINE HYDROCHLORIDE IN 0.9 % SODIUM CHLORIDE INTRAVENOUS PLASTIC BAG, INJECTION (ML) ML 10 MG/ML 0.3 2000 METHADONE METHADONE HYDROCHLORIDE SOLUTION ML 1 MG/ML > 0 TO </= 20 4; >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 METHADONE METHADONE HYDROCHLORIDE SOLUTION ML 2 MG/ML > 0 TO </= 20 4; >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 METHADONE METHADONE HYDROCHLORIDE SOLUTION-CONCENTRATED ML 10 MG/ML > 0 TO </= 20 4; >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 13 CALCULATION DEPENDENT ON DAILY DOSE CALCULATION DEPENDENT ON DAILY DOSE CALCULATION DEPENDENT ON DAILY DOSE
METHADONE METHADONE HYDROCHLORIDE TABLET TA 5 MG > 0 TO </= 20 4; CALCULATION DEPENDENT ON DAILY DOSE >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 METHADONE METHADONE HYDROCHLORIDE TABLET TA 10 MG > 0 TO </= 20 4; CALCULATION DEPENDENT ON DAILY DOSE >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 METHADONE METHADONE HYDROCHLORIDE INJECTION VIAL ML 10 MG/ML > 0 TO </= 20 4; CALCULATION DEPENDENT ON DAILY DOSE >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 METHADONE METHADONE HYDROCHLORIDE DISKETS TABLET, SOLUBLE TA 40 MG > 0 TO </= 20 4; CALCULATION DEPENDENT ON DAILY DOSE >20 TO </=40 8; > 40 TO </= 60 10; > 60 MG DAILY DOSE: 12 SULFATE TABLET, IR TA 15 MG 1 400 SULFATE TABLET,IR TA 30 MG 1 200 SULFATE INJECTION SOLUTION ML 0.5 MG/ML 3 4000 SULFATE INTRAVENOUS* SOLUTION ML 1 MG/ML 3 2000 SULFATE SOLUTION, ML 2 MG/ML 1 3000 SULFATE SOLUTION, ML 4 MG/ML 1 1500 SULFATE SOLUTION, ML 20 MG/ML 1 300 SULFATE RECTAL SUPPOSITORY EA 5 MG 1 1200 14
SULFATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) ML 5 MG/ML 3 400 SULFATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) ML 8 MG/ML 3 250 SULFATE RECTAL SUPPOSITORY EA 10 MG 1 600 SULFATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) ML 10 MG/ML 3 200 SULFATE INTRAMUSCULAR PEN INJECTOR (ML) ML 14.28571429 MG/ML 3 140 SULFATE / PF INJECTION AMPULE ML 0.5 MG/ML 3 4000 SULFATE / PF INJECTION AMPULE ML 1 MG/ML 3 2000 SULFATE / PF INJECTION AMPULE ML 10 MG/ML 3 200 SULFATE / DEXTROSE 5 % IN WATER INJECTION PLASTIC BAG, INJECTION (ML) ML 1 MG/ML 3 2000 SULFATE INTRAVENOUS SOLUTION ML 50 MG/ML 3 40 SULFATE / DEXTROSE 5 % IN WATER INJECTION PATIENT CONTROLLED ANALGESIA SYRINGE ML 2 MG/ML 3 1000 SULFATE / DEXTROSE 5%- WATER / PF SULFATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) INTRAVENOUS PLASTIC BAG, INJECTION (ML) ML 1 MG/ML 3 2000 ML 15 MG/ML 3 133.3333333 SULFATE RECTAL SUPPOSITORY EA 20 MG 1 300 SULFATE / DEXTROSE 5 % IN WATER INJECTION PLASTIC BAG, INJECTION (ML) ML 1 MG/ML 3 2000 SULFATE INTRAVENOUS SOLUTION ML 50 MG/ML 3 40 SULFATE INTRAVENOUS PRE-FILLED SYRINGE ML 8 MG/ML 3 250 SULFATE / PF INJECTION AMPULE ML 25 MG/ML 3 80 SULFATE IN 0.9 % SODIUM CHLORIDE INJECTION PREFILLED PUMP RESERVOIR ML 1 MG/ML 3 2000 SULFATE INTRAVENOUS PRE-FILLED SYRINGE ML 5 MG/ML 3 400 SULFATE INTRAVENOUS PRE-FILLED SYRINGE ML 4 MG/ML 3 500 SULFATE INTRAVENOUS PRE-FILLED SYRINGE ML 2 MG/ML 3 1000 SULFATE INTRAVENOUS SOLUTION ML 25 MG/ML 3 80 SULFATE INTRAAVENOUS PRE-FILLED SYRINGE ML 10 MG/ML 3 200 15
SULFATE IN 0.9 % SODIUM CHLORIDE INJECTION PREFILLED PUMP RESERVOIR ML 5 MG/ML 3 400 SULFATE RECTAL SUPPOSITORY EA 30 MG 1 200 SULFATE LIPOSOMAL / PF EPIDURAL VIAL (SDV,MDV OR ADDITIVE) (ML) SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE ML 10 MG/ML 3 200 CA 10 MG 1 600 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE CA 20 MG 1 300 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE CA 30 MG 1 200 SULFATE (KADIAN) CAPSULE, EXTENDED RELEASE EA 40 MG 1 150 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE CA 50 MG 1 120 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE EA 60 MG 1 100 SULFATE (KADIAN) CAPSULE, EXTENDED RELEASE EA 70 MG 1 85.71428571 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE CA 80 MG 1 75 SULFATE (KADIAN, GENERIC) CAPSULE, EXTENDED RELEASE EA 100 MG 1 60 SULFATE (KADIAN) CAPSULE, EXTENDED RELEASE EA 130 MG 1 46.15384615 SULFATE (KADIAN) CAPSULE, EXTENDED RELEASE EA 150 MG 1 40 16
SULFATE (KADIAN) CAPSULE, EXTENDED RELEASE EA 200 MG 1 30 SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR SULFATE (AVINZA, GENERIC) CAPSULE,EXTENDED RELEASE 24HR CA 30 MG 1 200 CA 45 MG 1 133.3333333 CA 60 MG 1 100 CA 75 MG 1 80 CA 90 MG 1 66.66666667 CA 120 MG 1 50 SULFATE (MS CONTIN, GENERIC) TABLET, EXTENDED RELEASE TA 15 MG 1 400 SULFATE (MS CONTIN, GENERIC) TABLET, EXTENDED RELEASE TA 30 MG 1 200 SULFATE (MS CONTIN, GENERIC) TABLET, EXTENDED RELEASE TA 60 MG 1 100 SULFATE (MS CONTIN, GENERIC) TABLET, EXTENDED RELEASE TA 100 MG 1 60 SULFATE (MS CONTIN, GENERIC) TABLET, EXTENDED RELEASE TA 200 MG 1 30 SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 20/0.8 MG 1 300 SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 30/1.2 MG 1 200 SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 50/2.0 MG 1 120 SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 60/2.4 MG 1 100 SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 80/3.2 MG 1 75 17
SULFATE/NALTREXONE (EMBEDA) EXTENDED RELEASE CAPSULE CA 100/4 MG 1 60 SULFATE CAPSULE,EXTENDED RELEASE 24HR NALBUPHINE NALBUPHINE HYDROCHLORIDE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) CA 20 MG 1 300 ML 10 MG/ML 3 200 NALBUPHINE NALBUPHINE HYDROCHLORIDE INJECTION SOLUTION ML 20 MG/ML 3 100 PENTAZOCINE NALOXONE HYDROCHLORIDE / TABLET TA 50 MG 0.37 324.3243243 PENTAZOCINE HYDROCHLORIDE HYDROCHLORIDE TABLET TA 5 MG 1.5 800 HYDROCHLORIDE CAPSULE CA 5 MG 1.5 800 HYDROCHLORIDE TABLET TA 10 MG 1.5 400 HYDROCHLORIDE TABLET TA 15 MG 1.5 266.6666667 HYDROCHLORIDE TABLET TA 20 MG 1.5 200 HYDROCHLORIDE TABLET TA 30 MG 1.5 133.3333333 HYDROCHLORIDE SOLUTION, ML 1 MG/ML 1.5 4000 HYDROCHLORIDE SOLUTION, ML 20 MG/ML 1.5 200 HYDROCHLORIDE (OXECTA) TABLET, ONLY TA 5 MG 1.5 800 HYDROCHLORIDE (OXECTA) TABLET, ONLY TA 7.5 MG 1.5 533.3333333 HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 10 MG 1.5 400 HYDROCHLORIDE (XTAMPZA TABLET EXTENDED RELEASE EA 9 MG 1.67 399.2015968 HYDROCHLORIDE TABLET EXTENDED RELEASE EA 15 MG 1.5 266.6666667 HYDROCHLORIDE (XTAMPZA TABLET EXTENDED RELEASE EA 13.5 MG 1.67 266.1343979 HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 20 MG 1.5 200 HYDROCHLORIDE (XTAMPZA TABLET EXTENDED RELEASE TA 18 MG 1.67 199.6007984 HYDROCHLORIDE CONCENTRATE, ML 20 MG/ML 1.5 200 HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 30 MG 1.5 133.3333333 18
HYDROCHLORIDE (XTAMPZA TABLET EXTENDED RELEASE TA 27 MG 1.67 133.0671989 HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 40 MG 1.5 100 HYDROCHLORIDE (XTAMPZA TABLET EXTENDED RELEASE HYDROCHLORIDE TABLET, EXTENDED RELEASE HYDROCHLORIDE TABLET, EXTENDED RELEASE 19 TA 36 MG 1.67 99.8003992 TA 60 MG 1.5 66.66666667 TA 80 MG 1.5 50 OXYMORPHONE OXYMORPHONE HYDROCHLORIDE INJECTION SOLUTION ML 1 MG/ML 30 200 OXYMORPHONE OXYMORPHONE HYDROCHLORIDE (OPANA TABLET TA 5 MG 3 400 AND GENERIC) OXYMORPHONE OXYMORPHONE HYDROCHLORIDE (OPANA TABLET TA 10 MG 3 200 AND GENERIC) OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 5 MG 3 400 OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE TABLET, EXTENDED RELEASE OXYMORPHONE OXYMORPHONE OXYMORPHONE OXYMORPHONE OXYMORPHONE OXYMORPHONE OXYMORPHONE OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA OXYMORPHONE HYDROCHLORIDE (OPANA TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TABLET, ONLY,EXTENDED RELEASE 12 HR TA 10 MG 3 200 TA 15 MG 3 133.3333333 TA 20 MG 3 100 TA 30 MG 3 66.66666667 TA 40 MG 3 50 TA 7.5 MG 3 266.6666667 TA 5 MG 3 400 TA 7.5 MG 3 266.6666667 TA 10 MG 3 200 TA 15 MG 3 133.3333333 TA 20 MG 3 100 TA 30 MG 3 66.66666667 TA 40 MG 3 50
PENTAZOCINE PENTAZOCINE LACTATE INJECTION VIAL (SDV,MDV OR ADDITIVE) (ML) TA 30 MG/ML 0.37 540.5405405 PENTAZOCINE PENTAZOCINE NALOXONE TABLET TA 50 MG 0.37 324.3243243 TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EA 50 MG 0.4 300 TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET, EXTENDED RELEASE TA 50 MG 0.4 300 TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EA 75 MG 0.4 200 TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EA 100 MG 0.4 150 TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET, EXTENDED RELEASE TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EXTENDED RELEASE TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EXTENDED RELEASE TAPENTADOL TAPENTADOL HYDROCHLORIDE TABLET EXTENDED RELEASE TRAMADOL TRAMADOL HYDROCHLORIDE TABLET DISPERSIBLE AND TABLET TRAMADOL TRAMADOL HYDROCHLORIDE TABLET,EXTENDED RELEASE MULTIPHASE 24 HR TA 100 MG 0.4 150 EA 150 MG 0.4 100 EA 200 MG 0.4 75 EA 250 MG 0.4 60 EA 50 MG 0.1 1200 TA 100 MG 0.1 600 TRAMADOL TRAMADOL HYDROCHLORIDE TABLET,EXTENDED RELEASE MULTIPHASE 24 HR TRAMADOL TRAMADOL HYDROCHLORIDE TABLET,EXTENDED RELEASE MULTIPHASE 24 HR TA 200 MG 0.1 300 TA 300 MG 0.1 200 20
REFERENCES 1. McPherson ML. Demystifying Opioid Conversion Calculations: A Guide to Effective Dosing, with 2011 Update. Bethesda, MD: American Society of Health-System Pharmacists; 2010. 2. CMS OMS HPMS Announcement to part D sponsors. July 11, 2014 Medicare Part D Overutilization Monitoring System-July 2014 Updates available at https://myteam1.medco.com/sites/medidocctr/lists/cms%20directives/attachments/1765/oms%20hpms%20announcement%20memo_july%202014.pdf. 3. Center for Disease Control and Prevention, Morphine Equivalent Conversion Factors for Opioids, 2011. Version CDC, Atlanta, GA, 2013. Cjones@cdc.gov 4. Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain: An educational aid to improve care and safety with opioid therapy 2010 Update. Available at http://www.agencymeddirectors.wa.gov/files/opioidgdline.pdf Accessed 11/15/2013 5. Opioid Dose calculator: available at http://agencymeddirectors.wa.gov/mobile.html or www.agencymeddirectors.wa.gov/files/dosingcalc.xls. Accessed 11/15/2013 6. Kane SP. Opioid Conversion Calculator ClinCalc: http://clinical.com/opioids/. Updated July 20, 2013. Accessed August 19, 2013. 7. Practical Pain management Opioid calculator. http://opioidcalculator.practicalpainmanagement.com/index.php Accessed August19, 2013 8. Global RPH Advanced Opioid Converter. Available at http://www.globalrph.com/opioidconverter2.htm Accessed 11/15/2013 9. US Department of Justice. Prescription Drug Monitoring Program Technical Assistance. http://www.pdmpassist.org/pdf/bja_performance_measure_aid_mme_conversion_tool.pdf Accessed 11/15/2013 10. Butorphanol Product Labeling. Available at http://www.drugs.com/pro/stadol.html. Accessed 11/15/2013. 11. https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/downloads/opioid-morphine-eq-conversion-factors-april-2017.pdf Appendix 9 Equianalgesic dosage table Buprenorphine (IM/IV): 0.4 Butorphanol (IM/IV): 2.0 Codeine (IM/IV): 120 Codeine (PO): 200 Fentanyl (IM/IV): 0.1 Fentanyl (Transdermal): 0.2 Hydrocodone (PO): 30 Hydromorphone (IV/IM/SC): 1.5 Hydromorphone (PO): 7.5 Levorphanol (acute PO): 4.0 Levorphanol (chronic PO): 1.0 Meperidine (IV/IM/SC): 75 Meperidine (PO): 300 Methadone (acute IV): 5.0 Methadone (acute PO): 10 Morphine (IV/IM/SC): 10 Morphine (acute PO): 60 Morphine (chronic PO): 30 Nalbuphine (IV/IM/SC): 10 Oxycodone (PO): 20 Oxymorphone (IV/IM/SC): 1.0 Oxymorphone (PO): 10 Tapentadol (PO): 75-100 21