Anthem Blue Cross (HMO, PPO, EPO)
Vicodin ES 7.5-300 Mg Tab (hydrocodone-acetaminophen)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Quantity Limit: 6 tablets per 1 day(s).

  • For FAX form click HERE
    Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
     Log in to Surescripts
     Log in to CoverMyMeds; For details on morphine equivalent dose criteria click  HERE
    For details on quantity criteria click  HERE
    7 days supply per fill; 14 days supply per 30 days
    For details on drug coverage click  HERE;