Analgesics
Analgesics, Narcotic

Brand/Generic Name Dosage/Strength Status Restrictions Notes Relative Cost
Ryzolt
TraMADol HCl		   nonform.gif (625 bytes)

ql.gif st.gif

Not Applicable
Ultram generic.gif (400 bytes)
TraMADol HCl		   approved.gif (510 bytes)  

$$
Ultram ER generic.gif (400 bytes)
TraMADol HCl		 Table SR 24 HR   nonform.gif (625 bytes)

ql.gif st.gif

NOTES_restrict.gif (377 bytes)

Not Applicable

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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