Health Net
OxyContin 160 Mg Tb12 (oxycodone)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Prior Authorization: Pain Narcotic: Opioid:
    Documented Diagnosis: Yes
    Age Requirement: >= 11
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Pain Narcotic: Opioid:
    Age Requirement: >= 11
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Diagnosis Type(s): Chronic Pain
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: Yes
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No

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