Analgesics
Analgesics, Narcotic

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Balacet 325 generic.gif (400 bytes)
Propoxyphene N-APAP		 Tab - 100-325 mg   nonform.gif (625 bytes)

mo.gif

NOTES_restrict.gif (377 bytes)

Not Applicable
Darvocet A500 generic.gif (400 bytes)
Propoxyphene N-APAP		 Tab - 100-500 mg   nonform.gif (625 bytes)

mo.gif

$$
Darvocet-N 100 generic.gif (400 bytes)
Propoxyphene N-APAP		   approved.gif (510 bytes)

mo.gif

NOTES_restrict.gif (377 bytes)

$
Darvocet-N 50
Propoxyphene N-APAP		   approved.gif (510 bytes)

mo.gif

NOTES_restrict.gif (377 bytes)

$

Key for Product(s) Listed Above
Formulary Prior Authorization (PA may not be required for some benefit plans) Non-Formulary
(Third tier coverage applies for selected plans)		 Not Reimbursed
Quantity Limit Not available through mail order as 90-day supply* Step Therapy Generic Available
Notes $Relative cost compared to others in category Specialty distribution for selected plans

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