Subject: Analgesics, Narcotics and Narcotic Combinations

Status	Drug	PR	PR-QL	PR-AL	ST	M EX‡
P	acetaminophen/codeine
P	aspirin/butalbital/caffeine
P	Balacet (propoxyphene-n 100/APAP 325)
P	butalbital/caffeine/codeine/ASA
P	butorphanol ns		X
P	dihydrocodeine combination
P	fentanyl patches		X
P	fentanyl transmucosal lozenge	X	X
P	hydrocodone/acetaminophen
P	hydrocodone/ibuprofen
P	hydromorphone
P	levorphanol
P	meperidine/promethazine
P	meperidine
P	methadone
P	methadose
P	morphine, morphine SR
P	Narvox™ (oxycodone w/ acetaminophen)
P	oxycodone
P	oxycodone hcl tab sr 12hr		X
P	oxycodone/acetaminophen
P	oxycodone/aspirin
P	oxycodone/ibu		X
P	OxyFast® (oxycodone)
P	pentazocine/acetaminophen
P	pentazocine/naloxone
P	percolone
P	propoxyphene HCl
P	propoxyphene napsylate/APAP
P	propoxyphene/aspirin/caffeine
P	tramadol
P	tramadol/apap
P	vicodin hp (hydrocodone/apap)
P	Avinza®  (morphine SR)
P	Kadian CR®  (morphine CR)
P	Opana ER®  (oxymorphone HCl)
P	Oxycontin CR®  (oxycodone hcl tab sr 12hr)		X
NP	Anexsia®  (hydrocodone/APAP)				X	X
NP	Bancap-HC®  (hydrocodone/APAP)				X	X
NP	Capital/Codeine®  (codeine/APAP)				X	X
NP	Darvocet-N®  (propoxyphene napsylate/APAP)				X	X
NP	Darvon®  (propoxyphene)				X	X
NP	Darvon Compound®  (aspirin/propoxyphene/caffeine)				X	X
NP	Dazidox™  (oxycodone hcl)
NP	Demerol®  (meperidine)
NP	Dilaudid®  (hydromorphone)
NP	Fioricet/Codeine®  (butalbital/APAP/caffeine/codeine)				X	X
NP	Fiorinal/Codeine®  (butalbital/aspirin/caffeine/codeine)				X	X
NP	Hycet™  (hydrocodone/APAP)
NP	Liquicet™  (hydrocodone/APAP)				X	X
NP	Lorcet®/Lorcet HD®/Lorcet Plus®  (hydrocodone/APAP)				X	X
NP	Lortab®/Lortab elixir  (hydrocodone/APAP)				X	X
NP	MS Contin®  (morphone sulfate)
NP	Norco®  (hydrocodone/APAP)				X	X
NP	Oxyir  (oxycodone)
NP	Panlor SS/DC  (APAP/caffeine/dihydrocod)
NP	Percodan®  (oxycodone/aspirin)				X	X
NP	Percocet®  (oxycodone/APAP)				X	X
NP	Reprexain®  (hydrocodone/ibuprofen)				X	X
NP	Roxicet®  (oxycodone/APAP)				X	X
NP	Roxicodone®  (oxycodone)
NP	Synalgos DC®  (dihydrocodeine compound)				X	X
NP	Talacen®  (pentazocine/APAP)				X	X
NP	Tylenol #3®  (codeine/APAP)				X	X
NP	Tylox®  (oxycodone/APAP)				X	X
NP	Vicodin/Vicodin ES®/Vicodin HP®  (hydrocodone/APAP)				X	X
NP	Vicoprofen®  (hydrocodone/ibuprofen)				X	X
NP	Vopac®  (codeine/APAP)				X	X
NP	Xodol®  (hydrocodone/APAP)				X	X
FE	Alcet™  (oxycodone/APAP)				X	X
FE	Actiq®  (fentanyl transmucosal lozenge)	X	X			X
FE	Combunox®  (oxycodone 5mg/ibuprofen 400mg)		X		X	X
FE	Duragesic®  (fentanyl transdermal)		X		X	X
FE	Fentora®  (fentanyl citrate buccal tab)	X	X	X	X	X
FE	Ibudone®  (hydrocodone-ibuprofen )				X	X
FE	Levo Dromora®  (levorphanol tartrate)					X
FE	Lynox®  (oxycodone/APAP)				X	X
FE	Magnacet™  (oxycodone/APAP)				X	X
FE	Maxidone®  (hydrocodone/APAP)				X	X
FE	Opana®  (oxymorphone HCl)					X
FE	Percocet® 2.5/325  (oxycodone/APAP)				X	X
FE	Perlox™  (oxycodone/APAP)					X
FE	Primalev™  (oxycodone w/ acetaminophen)					X
FE	Roxicet™ 5/500  (oxycodone/APAP)				X	X
FE	Trycet®  (propoxyphene-n 100/APAP 325)				X	X
FE	Ultracet®  (tramadol/APAP)					X
FE	Ultram®  (tramadol)				X	X
FE	Ultram ER®  (tramadol sr)				X	X
FE	Zydone®  (hydrocodone/APAP)				X	X
Note: Criteria for Anti-Migraine medications are discussed in the Pharmacy Clinical Policy Bulletin: Anti-Migraine- /products/rxnonmedicare/data/CNS/migraine_2007.html

Policy:

1. Precertification Criteria

Under some plans, including plans that use an open or closed formulary, Actiq, butorphanol ns, Combunox, Duragesic, fentanyl patch, fentanyl transmucosal lozenge, Fentora, oxycodone/ibu,oxycodone hcl tab sr 12hr, and OxyContin CR, are subject to precertification. If precertification requirements apply Aetna considers Actiq, butorphanol ns, Combunox, Duragesic, fentanyl patch, fentanyl transmucosal lozenge, Fentora, oxycodone/ibu, oxycodone hcl tab sr 12hr,  and OxyContin CR, to be medically necessary for those members who meet the following precertification criteria:

(A AND B) AND C  For Actiq, fentanyl transmucosal lozenge,  Fentora-ONLY

C - For butorphanol ns, Combunox, Duragesic, fentanyl patch, oxycodone/ibu, oxycodone hcl tab sr 12hr, OxyContin CR

A documented

A. Diagnosis of cancer

AND

B. Concomitant use of long acting opioid therapy*

AND

C. According to the manufacturer and/or clinical literature, Actiq, butorphanol ns, Combunox, Duragesic, fentanyl patch, fentanyl transmucosal lozenge, Fentora, oxycodone/ibu, oxycodone/ibu,oxycodone hcl tab sr 12hr, and OxyContin CR, can be dosed at the interval(s) indicated in the table below. A quantity of each drug will be considered medically necessary as indicated in the table below

Drug	Maximum Daily Dose/ Dosing Interval	Dosage Strength	Quantity Limits
fentanyl transmucosal lozenge(lpop) Actiq	1 lpop four times daily	200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg, 1600 mcg	Up to 15 lpop in 30 days**
oxycodone/ibu Combunox	1 tablet four times daily	5 mg/ 40 mg	Up to 120 tablets in 30 days
fentanyl patch Duragesic	1-2 patches every 72 hours	12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr	Up to 20 patches in 30 days (2 patches per 3 days)
Fentora	1 buccal tablet four times daily	100 mcg, 200 mcg, 300 mcg, 400 mcg, 600 mcg, 800 mcg	Up to 15 buccal tablets in 30 days**
oxycodone hcl tab sr 12hr, OxyContin CR	1-2 tablets every 12 hrs	10 mg, 15 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg	Up to 120 tablets in 30 days (320mg/day)
butorphanol	2-3 times daily	Nasal solution 10 mg/ml	Up to 2 bottles in 30 days





For coverage of additional quantities, member's treating physician must request prior authorization through the Aetna Pharmacy Management Precertification Unit.  Additional quantities of the above medications will be considered medically necessary for those members who meet the following criterion:

For Combunox, fentanyl patch, Duragesic, oxycodone/ibu, oxycodone hcl tab sr 12hr, OxyContin CR, butorphanol


• Member has diagnosis of cancer and prescription is written by an oncologist or pain specialist OR
• Member is enrolled in a hospice program or meets hospice criteria OR 
• Member has a diagnosis of moderate to severe chronic pain AND
  • A formal pain evaluation has been documented
    AND
  • Other pain management regimens have been inadequate
    AND
  • Member is documented to have failed dosing every 12 hours along with a prescription for immediate-release (IR) medication
    AND
  • Member's physician provides documentation (controlled clinical trial) from the peer-reviewed medical literature for use of a more frequent dosing interval (oxycodone hcl tab sr 12hr, OxyContin CR-only) OR
• Member has failed an every-72-hours regimen and requires dosing every 48 hours (Duragesic, fentanyl patch-only )OR 
• Member requires a regimen of Duragesic with more than one patch every 72 hours (Duragesic, fentanyl patch-only) OR
• Member requires a dose every 12 hours(BID) and the total daily dose is <320mg, AND the member has prior history of dose titration increasing incrementally (oxycodone hcl tab sr 12hr, OxyContin CR-only ) OR  
• Member is documented to have failed dosing every 12 hours along with a prescription for immediate-release (IR) medication AND Member's physician provides documentation (controlled clinical trial) from the peer-reviewed medical literature for use of a more frequent dosing interval (oxycodone hcl tab sr 12hr, OxyContin CR-only) OR
• Member's physician provides documentation (controlled clinical trial) from the peer-reviewed medical literature for use of a higher dose
  

           **For fentanyl transmucosal lozenge(lpop), Actiq ; Fentora 

• Member has current diagnosis of cancer (as the primary cause of the pain) and is currently on long-acting opioid and is being titrated on the long-acting opioid by physician AND 
• Member has tried and failed an adequate trial of two weeks of a single entity or combination pain medication containing an immediate release acting opioid (ex. oxycodone, morphine sulfate oral(Roxanol); oxymorphone(Opana); hydromorphone(Dilaudid); oxycodone/ibuprofen(Combunox); oxycodone/apap(Percocet)
  

 




2. Step Therapy Criteria

Under some plans, including plans that use an open or closed formulary, Alcet, Anexsia, Bancap HC Capital/Codeine, Combunox, Duragesic, Darvocet-N, Darvon, Darvon Compound, Duragesic, Fioricet/Codeine, Fiorinal/Codeine, Fentora, Ibudone, Liquicet,  Lorcet/HD/Plus, Lortab, Lortab elixir, Lynox, Magnacet, Maxidone,  Norco,  Percodan, Percocet, Percocet 2.5/325, Reprexain, Roxicet, Roxicet 5/500, Synalgos DC, Talacen, Tylenol #3, Tylox, Trycet, Ultram, Ultram ER, Vicodin, Vicodin ES, Vicoprofen, Vopac,  Xodol, and Zydone are subject to step-therapy.  Aetna considers these drugs to be medically necessary for those members who meet the following step-therapy criterion:

 

For Alcet, Anexsia, Bancap HC Capital/Codeine,  Darvocet-N, Darvon, Darvon Compound, Duragesic, Fioricet/Codeine, Fiorinal/Codeine, Fentora, Lorcet/HD/Plus, Lortab, Lortab elixir, Maxidone,  Norco, OxyContin CR, Percodan, Percocet, Roxicet, Talacen, Tylenol #3, Tylox, Trycet, Ultram, Vicodin, Vicodin ES,  and Vicoprofen
 
A documented trial of two days of the preferred generic equivalent alternative

 

For Combunox, Fentora, Ibudone, Liquicet, Lynox, Percocet 2.5/325, Reprexain, Roxicet 5/500, Synalgos DC, Ultram ER, Vopac, Zydone, and Xodol


For Combunox
A documented trial of two days of a preferred generic oxycodone combination alternative.

 

For Fentora
A documented trial of 1 week of the preferred generic fentanyl transmucosal lozenge  alternative

 

For Lynox, Magnacet, Percocet 2.5/325, Roxicet 5/500
A documented trial of two days of a preferred generic oxycodone/acetaminophen combination alternative.

 

For Ibudone, Reprexain,
A documented trial of two days of a preferred generic hydrocodone/ibuprofen combination alternative.

 

For Synalgos DC
A documented trial of two days of a preferred generic dihydrocodeine combination alternative

 

For Ultram ER
A documented trial of two days of a preferred generic tramadol alternative

 

For Vopac,
A documented trial of two days of a preferred generic acetaminophen/codeine combination alternative

 

For Liquicet, Xodol and Zydone
A documented trial of two days of a preferred generic hydrocodone/acetaminophen combination alternative


 

If it is medically necessary for a member to be treated initially with a medication subject to step-therapy, the member's treating physician may contact the Aetna Pharmacy Management Precertification Unit to request coverage as a medical exception at 1-800-414-2386. (See criteria under section III below).

 

 

3. Medical Exception Criteria

Anexsia, Bancap HC Capital/Codeine,  Darvocet-N, Darvon, Darvon Compound, Fioricet/Codeine, Fiorinal/Codeine, , Lorcet/HD/Plus, Lortab, Lortab elixir, Norco,  Percodan, Percocet, , Reprexain, Roxicet, Synalgos DC, Talacen, Tylenol #3, Tylox, Vicodin, Vicodin ES/HP, Vicoprofen, Vopac,  Xodol, and are currently listed on the Step-Therapy List.* Therefore, these are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary or that require step-therapy criteria, unless a medical exception is granted.  Aetna considers them to be medically necessary for those members who meet the criteria below:

Alcet, Combunox, Duragesic, Fentora, Ibudone,  Lynox, Magnacet, Maxidone, Percocet 2.5/325, Roxicet 5/500, Trycet, Ultram, Ultram ER, Zydone are currently listed on the Aetna Formulary Exclusions and Step-Therapy lists.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary or that require step-therapy criteria, unless a medical exception is granted.  Aetna considers these drugs to be medically necessary for those members who meet the criteria specified below:

Actiq, Levo Dromora, Opana, Perlox, Primalev, Ultracet are currently listed on the Aetna Formulary Exclusions List.* Therefore, these are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted.  Aetna considers these drugs to be medically necessary for those members who meet the criteria specified below:

For Alcet, Anexsia, Bancap HC Capital/Codeine, Darvocet-N, Darvon, Darvon Compound, Duragesic, Fioricet/Codeine, Fiorinal/Codeine, Fentora, Lorcet/HD/Plus, Lortab, Lortab elixir, Maxidone,  Norco, Percodan, Percocet, Roxicet, Talacen, Tylenol #3, Tylox, Trycet, Ultram, Vicodin, Vicodin ES, and Vicoprofen

A.  A documented:

• Contraindication to the preferred generic equivalent alternative OR
• Intolerance to the preferred generic equivalent alternative OR
• Allergy to the preferred generic equivalent alternative OR
• Failure of an adequate clinical trial of two days of the preferred generic equivalent alternative.

For Combunox, Fentora, Lynox, Magnacet, Percocet 2.5/325, Reprexain, Roxicet 5/500, Synalgos DC, Ultram ER, Vopac, Zydone tab, and Xodol

For Combunox
A.  A documented:

• Contraindication to a  preferred generic oxycodone combination alternative OR
• Intolerance to a preferred generic oxycodone combination alternative OR
• Allergy to a preferred generic oxycodone combination alternative OR 
• Failure of an adequate clinical trial of two days of a preferred generic oxycodone combination alternative

For Fentora
A documented
A. Diagnosis of cancer

AND

B. Concomitant use of long acting opioid therapy*

AND
C.  A documented:

• Contraindication to the preferred generic fentanyl transmucosal lozenge  alternative OR
• Intolerance to the preferred generic fentanyl transmucosal lozenge  alternative OR 
• Allergy to the preferred generic fentanyl transmucosal lozenge  alternative OR  
• Failure of an adequate clinical trial of one week of the preferred generic fentanyl transmucosal lozenge alternative
  

For Lynox, Magnacet, Percocet 2.5/325, Roxicet 5/500
A.  A documented:

• Contraindication to a preferred generic oxycodone/acetaminophen combination alternative OR
• Intolerance to a preferred generic oxycodone/acetaminophen combination alternative OR
• Allergy to a preferred generic oxycodone/acetaminophen combination alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic oxycodone/acetaminophen combination alternative.

For Ibudone, Reprexain
A.  A documented: 

• Contraindication to a preferred generic hydrocodone/ibuprofen combination alternative OR
• Intolerance to a preferred generic hydrocodone/ibuprofen combination alternative OR
• Allergy to a preferred generic hydrocodone/ibuprofen combination alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic hydrocodone/ibuprofen combination alternative

For Synalgos DC
A.  A documented: 

• Contraindication to a preferred generic dihydrocodeine combination alternative OR
• Intolerance to a preferred generic dihydrocodeine combination alternative OR
• Allergy to a preferred generic dihydrocodeine combination alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic dihydrocodeine combination alternative

For Ultram ER
A. A documented:

• Contraindication to a preferred generic tramadol alternative OR
• Intolerance to a preferred generic tramadol alternative OR 
• Allergy to a preferred generic tramadol alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic tramadol alternative

For Vopac,
A. A documented:

• Contraindication to a preferred generic acetaminophen/codeine combination alternative OR 
• Intolerance to a preferred generic acetaminophen/codeine combination alternative OR
• Allergy to a preferred generic acetaminophen/codeine combination alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic acetaminophen/codeine combination alternative

For Xodol and Zydone
A. A documented:

• Contraindication to a preferred generic hydrocodone/acetaminophen combination alternative OR 
• Intolerance to a preferred generic hydrocodone/acetaminophen combination alternative OR 
• Allergy to a preferred generic hydrocodone/acetaminophen combination alternative OR
• Failure of an adequate clinical trial of two days of a preferred generic hydrocodone/acetaminophen combination alternative
   

Actiq, Alcet,  Levo Dromora, Opana, Perlox,  Primalev and Ultracet are currently listed on the Aetna Formulary Exclusions List.* Therefore, these are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted.  Aetna considers these to be medically necessary for those members who meet the following criteria: 

A AND B AND C For Actiq ONLY
C- For Alcet,  Levo Dromora, Opana; Perlox, Primalev,  Ultracet


A. Diagnosis of cancer

AND

B. Concomitant use of long acting opioid therapy*

AND
C.  A documented:  

• Contraindication to two preferred analgesics, either narcotic analgesics (single entity or combination products) OR  
• Intolerance to two preferred analgesics, either narcotic analgesics (single entity or combination products) OR  
• Allergy to two preferred analgesics, either narcotic analgesics (single entity or combination products) OR  
• Failure of an adequate clinical trial of two days each of at least two preferred analgesics, either narcotic analgesics (single entity or combination products).
  

Special Notes:

*Examples of Long acting opioid therapy
  controlled-release morphine (MS Contin, Oramorph SR, Kadian CR)
  extended-release morphine (Avinza)
  controlled-release oxycodone (Oxycontin CR)
  extended-release oxymorphone (Opana ER)
  fentanyl transdermal (Duragesic)
  methadone (Dolophine, Methadose)

            Approximate Equianalgesic Dosing of Opioid Analgesics in Adults

Drug	Duration	Half-life	Route	Equianalgesic Dosage
Codeine	4–6 h	3 h	IM	120 mg
			PO	200 mg
Fentanyl Sublimaze Duragesic Patch	1–2 h	1.5–6 h	IM	0.1 mg
				Transdermal Patch 25mcg/hr (for chronic pain only) roughly equivalent to oral morphine 50mg/24hr. Upward titration of patch no more frequently than every 3 days
Hydrocodone Lorcet Lortab Vicodin	4–8 h	3.3–4.5 h	PO	30 mg
Hydromorphone Dilaudid	4–5 h	2–3 h	IM	1.3–1.5 mg
			PO	7.5 mg
Levorphanol Levo-Dromora	6–8 h	12–16 h	IM	2 mg
			PO	4 mg
Meperidine Demerol	2–4 h	3–4 h	IM	75 mg
			PO	300 mg
Methadone Dolophine	4–6 h	15–30 h	IM	10 mg
			PO	10–20 mg
Morphine Roxanol	3–7 h	1.5–2 h	IM	10 mg
			PO	30–60 mg
Extended-release morphine -Avinza	Q24hr		PO	30
Controlled-release morphine MS Contin Oramorph SR Kadian			IM	NA
	12 hr Kadian may be given as 60mg        q 24hr		PO	30
Oxycodone Roxicodone, OxyIR, Percocet Percodan Tylox, others	4–6 h	NA	PO	15-30 mg (20 mg)
Controlled-release oxycodone OxyContin	12 hr	NA	PO	20
Oxymorphone Opana Opana ER	3–6 h	NA	IM	1 mg
		NA	PO	10 mg
	12hr	NA	PO	10 mg
Propoxyphene	4–6 h	6–12 h	PO	130-200 mg *
				(Inconclusive data)

 

Place of Service:

Outpatient

The above policy is based on the following references:

1. Caldwell JR, Rapoport RJ, Davis JC, et al. Efficacy and safety of a once-daily morphine formulation in chronic, moderate-to-severe osteoarthritis pain: results from a randomized, placebo-controlled, double-blind trial and an open label extension trial. J Pain Symptom Management 2002;23:278-91.
2. Douglas MD, Garland WT, Kelly JB, et al. Efficacy of a new, once-daily, rapid-onset, extended-release morphine formulation (Morphelan) and a twice-daily morphine sulfate controlled-release formulation (MS Contin) in patients with chronic, moderate-to-severe pain [abstract #780]. Presented at the 20^th Annual Scientific Meeting of the American Pain Society, Phoenix, AZ, April 19-22, 2001.
3. Portenoy RK, Sciberras A, Eliot L, et al. Steady-state pharmacokinetic comparison of a new, extended-release, once-daily morphine formulation, Avinza, and a twice-daily controlled-release morphine formulation in patients with chronic moderate-to-severe pain. J Pain Symptom Management 2002;23:292-300.
4. Richards D, Simmonds M, Shelby S, et al. Once daily, rapid onset extended release morphine in patients with chronic malignant pain. Abstract #1559. Presented at the American Society of Clinical Oncology, San Francisco, CA, May 12-15, 2001.
5. Anon. Drugs for pain. Med Lett Drugs Ther. 1998;40(1033):79-84.
6. Quigley C. Hydromorphone for acute and chronic pain. Cochrone Database Syst Rev. 2002;(1):CD003447.
7. Broomhead A, Kerr R, Tester W, O’Meara P, Maccarrone C, et al.  Comparison of a once-a day sustained-release morphine formulation with standard oral morphine treatment for cancer pain.  J Pain Symptom Manage 1997; 14 (2): 63-73.
8. Kerr R, Tester W.  A patient preference study comparing two extended-release morphine sulfate formulations (once-daily Kadian versus twice-daily MS Contin) for cancer pain.  Clin Drug Invest 2000; 19 (1): 25-32.
9. Rischitelli DG, Karbowicz SH. Safety and efficacy of controlled-release oxycodone: A systematic literature review. Pharmacotherapy 2002;22(7):898-904.
10. American Pain Society.  Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain 4th ed.  Glenview, IL:  American Pain Society, 1999.
11. Kaplan R, Parris WC-V, Citron ML, et al.  Comparison on controlled-release and immediate-release oxycodone tablets inpatients with cancer pain.  J Clin Oncol. 1998;16(10):3230-3237
12. Heiskanen T, Kalso E. Controlled-release oxycodone and morphine in cancer related pain.  Pain.  1997;73:37-45.
13. Citron ML, Kaplan R, Parris WC-V, et al.  Long-term administration of controlled-release oxycodone tablets for the treatment of cancer pain.  Cancer Invest. 1998;16(8):562-571.
14. Mucci-LoRusso P, Berman BS, Silberstein PT, et al.  Controlled-release oxycodone compared with controlled-release morphine in the treatment of cancer pain:  a randomized, double-blind, parallel-group study.  Eur J Pain.  1998;2:239-249.
15. 15. DrugPoints® System ( www.statref.com) Thomson Micromedex, Greenwood Village, CO. Updated periodically. 
16. AHFS Drug Information® with AHFSfirstReleases®. ( www.statref.com), American Society Of Health-System Pharmacists®, Bethesda, MD. Updated periodically. 
17. DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically. 
18. Drug Facts and Comparisons on-line. (www.drugfacts.com), Wolters Kluwer Health, St. Louis, MO. Updated periodically. 
19. PDR® Electronic Library™ [Internet database]. Greenwood Village, Colo: Thomson Micromedex. Updated periodically.
    Product Information Opana® and OpanaER® accessed at http://opana.com/
20. National Cancer Institute. Basic Principles of Cancer Pain Management. NCI website. http://www.cancer.gov/cancertopics/pdq/supportivecare/ pain/healthprofessional/.
21. Pereira J, Lawlor P, Vigano A, et al. Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage 2001;22:672-87. 
22. Anderson R, Saiers JH, Abram S, Schlicht C. Accuracy in equianalgesic dosing. conversion dilemmas. J Pain Symptom Manage 2001;21:397-406 
23. OxyContin generic approved by Mallinckrodt manufacturer. CDER site accessed 9-5-08 at: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Generics 
24. Agreement allows Mallinckrodt to start selling a generic version of painkiller OxyContin article accessed 9-22-08 at: http://biz.yahoo.com/ap/080902/oxycontin_generic_version.html?.v=1
    
    

 

 

Copyright Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

October 01, 2008