Health Net
Xartemis XR (oxycodone-acetaminophen)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Pain Narcotic: Opioid:
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 3 month(s)
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: No
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No

  • Prior Authorization: Pain Narcotic: Opioid:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Pain Narcotic: Opioid:
    ST Multiple Generics

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