Drugs for Pain and Fever
Arthritis and Pain Drugs

BRAND NAME: Vicodin ES 7.5-750 Mg Tab - generic.gif (400 bytes) Generic Available
Note: Brand name drugs are listed for reference only. The approval status and restrictions indicated below apply only to the brand's generic equivalent. Certain brand drugs may not be covered by your health plan. Please contact your health plan for additional information.

GENERIC NAME: 
hydrocodone-acetaminophen
  Status Notes or Restrictions
Anthem Blue Cross - 2014 to Present (HMO, PPO, EPO) notlisted.gif (324 bytes)  
HealthNet - All plan years notlisted.gif (324 bytes)  
Kaiser Foundation Health Plan Northern California - All plan years preferred.gif (540 bytes)  
Kaiser Foundation Health Plan Southern California - All plan years preferred.gif (540 bytes)  
Oscar Health - 2018 to Present notreimb.gif (645 bytes)  
Sharp Health Plan - All plan years notlisted.gif (324 bytes)  
Sutter Health Plus notlisted.gif (324 bytes)  
UnitedHealthcare - 2014 to Present notlisted.gif (324 bytes)  
Western Health Advantage - All plan years notlisted.gif (324 bytes)  


preferred.gif (540 bytes)  Preferred

approved.gif (510 bytes)   Approved

priorauth.gif (816 bytes)  Prior Auth.

nonform.gif (625 bytes)    Non-Formulary notreimb.gif (645 bytes)   Not Reimbursed notlisted.gif (324 bytes)   Not Listed
nonform.gif (625 bytes)    Benefits/Policies generic.gif (400 bytes) Generic Available, Brand Listed for reference only. Brand may not be covered.

NOTES.gif (377 bytes)NOTES_restrict.gif (372 bytes)

Notes or
Restrictions

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