Health Net
Prialt (ziconotide)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Pain Narcotic: Opioid:
    Duration: 1 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: No
    Morphine Equivalent Dose (MED) Limit: <= 90 mg/day
    Morphine Equivalent Dose (MED) Required: Yes

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

  • Prior Authorization: Pain Narcotic: Opioid:
    Documented Diagnosis: Yes
    Duration: 1 Month(s)

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