2023 Medication Search - Peoples Health Medicare Advantage in Louisiana

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Your doctor may need to provide additional information to your pharmacist when you fill a prescription for this drug. Additional quantity limits may apply across all drugs in the opioid class used for the treatment of pain. This additional limit is called a cumulative morphine milligram equivalent (MME) and is designed to monitor safe dosing levels of opioids for individuals who may be taking more than 1 opioid drug for pain management. If your doctor prescribes more than this amount or thinks the limit is not right for your situation, you or your doctor can ask the plan to cover the additional quantity.

Denotes a drug that is not covered.

BUPRENORPHIN DIS 10MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 4 per 28-days (* depending on package size)
BUPRENORPHIN DIS 15MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 4 per 28-days (* depending on package size)
BUPRENORPHIN DIS 20MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 4 per 28-days (* depending on package size)
BUPRENORPHIN DIS 5MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 4 per 28-days (* depending on package size)
BUPRENORPHIN DIS 7.5/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 4 per 28-days (* depending on package size)
FENTANYL DIS 100MCG/H
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 15 per 30-days (* depending on package size)
FENTANYL DIS 12MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 15 per 30-days (* depending on package size)
FENTANYL DIS 25MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 15 per 30-days (* depending on package size)
FENTANYL DIS 50MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 15 per 30-days (* depending on package size)
FENTANYL DIS 75MCG/HR
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 15 per 30-days (* depending on package size)
HYDROMORPHON TAB 12MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 60 per 30-days (* depending on package size)
HYDROMORPHON TAB 16MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 60 per 30-days (* depending on package size)
HYDROMORPHON TAB 32MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 60 per 30-days (* depending on package size)
HYDROMORPHON TAB 8MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 60 per 30-days (* depending on package size)
LEVORPHANOL TAB 2MG
Classification: Tier 5 (specialty tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 180 per 30-days (* depending on package size)
LEVORPHANOL TAB 3MG
Classification: Tier 5 (specialty tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 180 per 30-days (* depending on package size)
METHADONE CON 10MG/ML
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 360 per 30-days (* depending on package size)
METHADONE INJ 10MG/ML
Classification: Tier 5 (specialty tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
METHADONE SOL 10MG/5ML
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 1800 per 30-days (* depending on package size)
METHADONE SOL 5MG/5ML
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 3600 per 30-days (* depending on package size)
METHADONE TAB 10MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 360 per 30-days (* depending on package size)
METHADONE TAB 40MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
METHADONE TAB 5MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 240 per 30-days (* depending on package size)
METHADOSE CON 10MG/ML
Classification: Tier 3 (preferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 360 per 30-days (* depending on package size)
METHADOSE TAB 40MG
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
METHADOSE SF CON 10MG/ML
Classification: Tier 3 (preferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 360 per 30-days (* depending on package size)
MITIGO INJ 10MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Prior Authorization: Part B vs. Part D Prior Authorization
MITIGO INJ 25MG/ML
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Prior Authorization: Part B vs. Part D Prior Authorization
MORPHINE SUL TAB 100MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
MORPHINE SUL TAB 15MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
MORPHINE SUL TAB 200MG ER
Classification: Tier 4 (nonpreferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 60 per 30-days (* depending on package size)
MORPHINE SUL TAB 30MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 120 per 30-days (* depending on package size)
MORPHINE SUL TAB 60MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 120 per 30-days (* depending on package size)
TRAMADOL HCL TAB 100MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 30 per 30-days (* depending on package size)
TRAMADOL HCL TAB 200MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 30 per 30-days (* depending on package size)
TRAMADOL HCL TAB 300MG ER
Classification: Tier 3 (preferred brand tier) generic drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 30 per 30-days (* depending on package size)
XTAMPZA ER CAP 13.5MG
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
XTAMPZA ER CAP 18MG
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
XTAMPZA ER CAP 27MG
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 180 per 30-days (* depending on package size)
XTAMPZA ER CAP 36MG
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 180 per 30-days (* depending on package size)
XTAMPZA ER CAP 9MG
Classification: Tier 4 (nonpreferred brand tier) brand drug
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
Quantity Limit: 90 per 30-days (* depending on package size)
BELBUCA MIS 150MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 300MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 450MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 600MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 750MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 75MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BELBUCA MIS 900MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BUTRANS DIS 10MCG/HR
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BUTRANS DIS 15MCG/HR
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BUTRANS DIS 20MCG/HR
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BUTRANS DIS 5MCG/HR
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
BUTRANS DIS 7.5/HR
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
CONZIP CAP 100MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
CONZIP CAP 200MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
CONZIP CAP 300MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
FENTANYL DIS 37.5MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
FENTANYL DIS 62.5MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
FENTANYL DIS 87.5MCG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 10MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 15MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 20MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 30MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 40MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE CAP 50MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 100MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 120MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 20MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 30MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 40MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 60MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYDROCODONE TAB 80MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 100 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 120 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 20 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 30 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 40 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 60 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
HYSINGLA ER TAB 80 MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
INFUMORPH INJ 10MG/ML
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
INFUMORPH INJ 25MG/ML
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL BEADS CAP 60MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 100MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 10MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 120MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 20MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 30MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 40MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 45MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 50MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 60MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 75MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 80MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MORPHINE SUL CAP 90MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MS CONTIN TAB 100MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MS CONTIN TAB 15MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MS CONTIN TAB 200MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MS CONTIN TAB 30MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
MS CONTIN TAB 60MG ER
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting
NUCYNTA ER TAB 100MG
Classification: Not Covered
Therapeutic Category: Analgesics
Therapeutic Class: Opioid Analgesics, Long-acting

Last updated 10/02/2023

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