WHA

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Guideline Drug Name
Opioid Quantity Limit Overrides Opioid quantity limit override
Opioid Risk Management ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE, ACETAMINOPHEN/CODEINE, ACETAMINOPHEN/CODEINE #3, ACETAMINOPHEN/CODEINE PHOSPHATE, APADAZ, BELBUCA, BENZHYDROCODONE/ACETAMINOPHEN, BUPRENORPHINE, BUPRENORPHINE BUCCAL, BUTORPHANOL TARTRATE, BUTRANS, CAPCOF, CHERATUSSIN AC, CODEINE SULFATE, CODEINE/ACETAMINOPHEN, CODEINE/GUAIFENESIN, CODITUSSIN AC, CODITUSSIN DAC, DILAUDID, ENDOCET, FENTANYL, G TUSSIN AC, GUAIATUSSIN AC, GUAIFENESIN AC, GUAIFENESIN/CODEINE, HYCET, HYDROCODONE BITARTRATE ER, HYDROCODONE BITARTRATE/ACETAMINOPHEN, HYDROCODONE BITARTRATE/HOMATROPINE METHYLBROMIDE, HYDROCODONE POLISTIREX/CHLORPHENIRAMINE POLISTIREX, HYDROCODONE/ACETAMINOPHEN, HYDROCODONE/HOMATROPINE, HYDROCODONE/IBUPROFEN, HYDROMET, HYDROMORPHONE HCL, HYDROMORPHONE HCL ER, HYDROMORPHONE HYDROCHLORIDE ER, HYSINGLA ER, LORTUSS EX, M-CLEAR WC, M-END PE, MAR-COF BP, MAR-COF CG EXPECTORANT, MEPERIDINE HCL, METHADONE HCL, METHADONE HYDROCHLORIDE, MORPHINE SULFATE, MORPHINE SULFATE CR, MORPHINE SULFATE ER, MS CONTIN, NALOCET, NINJACOF-XG, NUCYNTA, NUCYNTA ER, OPANA, OXAYDO, OXYCODONE HCL, OXYCODONE HCL ER, OXYCODONE HYDROCHLORIDE, OXYCODONE HYDROCHLORIDE/ACETAMINOPHEN, OXYCODONE/ACETAMINOPHEN, OXYCODONE/ASPIRIN, OXYCODONE/IBUPROFEN, OXYCONTIN, OXYMORPHONE HYDROCHLORIDE, OXYMORPHONE HYDROCHLORIDE ER, PENTAZOCINE/NALOXONE HCL, PERCOCET, POLY-TUSSIN AC, PRO-RED AC, PROLATE, PROMETHAZINE VC/CODEINE, PROMETHAZINE/CODEINE, PROMETHAZINE/PHENYLEPHRINE/CODEINE, QDOLO, RELCOF C, ROXICODONE, ROXYBOND, RYDEX, TRAMADOL HCL, TRAMADOL HYDROCHLORIDE, TRAMADOL HYDROCHLORIDE/ACETAMINOPHEN, TREZIX, TUXARIN ER, TUZISTRA XR, TYLENOL/CODEINE #3, TYLENOL/CODEINE #4, ULTRACET, ULTRAM, VIRTUSSIN A/C, XTAMPZA ER
Oral Fentanyl Products Actiq (fentanyl citrate) oral transmucosal lozenge, Fentora (fentanyl buccal tablet), Lazanda (fentanyl) nasal spray, Subsys (fentanyl sublingual spray)
Orencia (abatacept) Orencia (abatacept) IV, Orencia (abatacept) IV, SC
Orgovyx (relugolix) Orgovyx (relugolix)
Orkambi (lumacaftor/ivacaftor) Orkambi (lumacaftor/ivacaftor)
Orserdu (elacestrant) Orserdu (elacestrant)
Otezla (apremilast) Otezla (apremilast)
Overactive Bladder Agents Gelnique (oxybutynin chloride)
PCSK9 Inhibitors - PA, ST, NF Praluent (alirocumab), Repatha (evolocumab)
Piqray (alpelisib) Piqray (alpelisib)
Pomalyst (pomalidomide) Pomalyst (pomalidomide)
Prior Authorization Administrative Guideline Admin, Administrative, albendazole, albenza, Prior Authorization
Promacta (eltrombopag) Promacta (eltrombopag olamine)
Proton Pump Inhibitors Aciphex (rabeprazole), Aciphex Sprinkle (rabeprazole), Dexilant (dexlansoprazole), Konvomep (omeprazole and sodium bicarbonate), Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole), Protonix (pantoprazole), Zegerid (omeprazole/sodium bicarbonate)
Provigil (modafinil), Nuvigil (armodafinil) Nuvigil (armodafinil), Provigil (modafinil)
Pulmonary Arterial Hypertension Agents Adcirca (tadalafil) Tablets, Alyq (tadalafil) Tablets, Tadliq (tadalafil) Oral Suspension, Adempas (riociguat) Tablets, Flolan (epoprostenol sodium) Injection, Letairis (ambrisentan) Tablets, Liqrev (sildenafil) suspension, Opsumit (macitentan) Tablets, Opsynvi (macitentan/ tadalafil) Tablets, Orenitram (treprostinil) Tablets, Remodulin (treprostinil sodium) Injection, Revatio (sildenafil) Injection, Tablets, Oral Suspension, Tracleer (bosentan) Tablets, Tablets for Suspension, Tyvaso (treprostinil) Inhalation Solution, Tyvaso (treprostinil) DPI Inhalation Powder, Uptravi (selexipag) Tablets and Injection, Veletri (epoprostenol) Injection, Ventavis (iloprost) Inhalation Solution, Winrevair (sotatercept-csrk) Injection, Yutrepia (treprostinil) capsule
Pulmozyme (dornase alfa inhalation solution) Pulmozyme (dornase alpha) Inhalation Solution
Pyrukynd (mitapivat) Pyrukynd (mitapivat)
Qinlock (ripretinib) Qinlock (ripretinib)