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Department of Labor: Division of Industrial Affairs >> Office of Workers' Compensation

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     OWC PREFERRED DRUG LIST

Use the formulary below only for NSAID analgesics, opiod analagesics, skeletal muscle relaxants. Physicians are encouraged to prescribe generic drugs. If the physician feels it is medically necessary to prescribe a non- preferred drug and there is no generic equivalent then it can be done without prior authorization. Please note that the Reference Trade Name listed below is used only as an example of the generic drug.

The use of sustained release/controlled release medication may be used when a continuous around-the-clock analgesic is needed for moderate to severe pain requiring treatment for an extended period of time.
ANALGESICS: NSAIDs

PREFERRED DRUG

Reference Trade Name

DICLOFENAC POTASSIUM 50MG TABLET ORAL CATAFLAM 50 MG TABLET
DICLOFENAC SODIUM 100MG TAB.SR 24H ORAL VOLTAREN-XR 100 MG TABLET
DICLOFENAC SODIUM 25MG TABLET DR ORAL VOLTAREN 25 MG TABLET EC
DICLOFENAC SODIUM 50MG TABLET DR ORAL VOLTAREN 50 MG TABLET EC
DICLOFENAC SODIUM 75MG TABLET DR ORAL VOLTAREN 75 MG TABLET EC
DIFLUNISAL 250MG TABLET ORAL DOLOBID 250MG TABLET
DIFLUNISAL 500MG TABLET ORAL DOLOBID 500 MG TABLET
ETODOLAC 200MG CAPSULE ORAL LODINE 200 MG CAPSULE
ETODOLAC 300MG CAPSULE ORAL LODINE 300 MG CAPSULE
ETODOLAC 400MG TAB.SR 24H ORAL LODINE XL 400MG TABLET SA
ETODOLAC 400MG TABLET ORAL LODINE 400 MG TABLET
ETODOLAC 500MG TAB.SR 24H ORAL LODINE XL 500 MG TABLET SA
ETODOLAC 500MG TABLET ORAL LODINE 500MG TABLET
ETODOLAC 600MG TAB.SR 24H ORAL LODINE XL 600MG TABLET SA
FENOPROFEN CALCIUM 200MG CAPSULE ORAL NALFON 200 MG PULVULE
FENOPROFEN CALCIUM 300MG CAPSULE ORAL NALFON 300 MG CAPSULE
FENOPROFEN CALCIUM 600MG TABLET ORAL NALFON 600MG TABLET
FLURBIPROFEN 100MG TABLET ORAL ANSAID 100 MG TABLET
FLURBIPROFEN 50MG TABLET ORAL ANSAID 50MG TABLET
IBUPROFEN 100MG TAB CHEW ORAL ADVIL 100 MG TABLET CHEW
IBUPROFEN 100MG TABLET ORAL MOTRIN 100MG CAPLET
IBUPROFEN 100MG/5ML GEL ORAL ELIXSURE IB SUSPENSION
IBUPROFEN 100MG/5ML ORAL SUSP ORAL MOTRIN 100 MG/5 ML SUSPENSION
IBUPROFEN 200MG CAPSULE ORAL ADVIL MIGRAINE 200 MG CAPSULE
IBUPROFEN 200MG TABLET ORAL MOTRIN IB 200 MG CAPLET
IBUPROFEN 300MG TABLET ORAL MOTRIN 300 MG TABLET
IBUPROFEN 400MG TABLET ORAL MOTRIN 400 MG TABLET
IBUPROFEN 40MG/ML DROPS SUSP ORAL MOTRIN 40MG/ML SUSP DROPS
IBUPROFEN 50MG TAB CHEW ORAL MOTRIN 50MG TABLET CHEWABLE
IBUPROFEN 600MG TABLET ORAL MOTRIN 600 MG TABLET
IBUPROFEN 800MG TABLET ORAL MOTRIN 800 MG TABLET
INDOMETHACIN 25MG CAPSULE ORAL INDOCIN 25MG CAPSULE
INDOMETHACIN 25MG/5ML ORAL SUSP ORAL INDOCIN 25 MG/5 ML SUSPENSION
INDOMETHACIN 50MG CAPSULE ORAL INDOCIN 50MG CAPSULE
INDOMETHACIN 50MG RECTAL SUPPOSITORY INDOCIN 50 MG SUPPOSITORY
INDOMETHACIN 75MG CAPSULE SA ORAL INDOCIN SR 75MG CAPSULE SA
KETOPROFEN 100MG PELLETED 24HR CAPSULE ORAL ORUVAIL 100MG CAPSULE SA
KETOPROFEN 12.5MG TABLET ORAL ORUDIS KT 12.5 MG TABLET
KETOPROFEN 150MG PELLETED 24HR CAPSULE ORAL ORUVAIL 150MG CAPSULE SA
KETOPROFEN 200MG PELLETED 24HR CAPSULE ORAL ORUVAIL 200 MG CAPSULE SA
KETOPROFEN 25MG CAPSULE ORAL ORUDIS 25MG CAPSULE
KETOPROFEN 50MG CAPSULE ORAL ORUDIS 50MG CAPSULE
KETOPROFEN 75MG CAPSULE ORAL ORUDIS 75MG CAPSULE
KETOROLAC TROMETHAMINE 10MG TABLET ORAL TORADOL 10 MG TABLET
MECLOFENAMATE SODIUM 100MG CAPSULE ORAL MECLOMEN 100MG CAPSULE
MECLOFENAMATE SODIUM 50MG CAPSULE ORAL MECLOMEN 50MG CAPSULE
NABUMETONE 500MG TABLET ORAL RELAFEN 500 MG TABLET
NABUMETONE 750MG TABLET ORAL RELAFEN 750 MG TABLET
NAPROXEN 125MG/5ML ORAL SUSP ORAL NAPROSYN 125 MG/5 ML SUSPENSION
NAPROXEN 250MG TABLET ORAL NAPROSYN 250 MG TABLET
NAPROXEN 375MG TABLET DELAYED-RELEASE ORAL EC-NAPROSYN 375 MG TABLET
NAPROXEN 375MG TABLET ORAL NAPROSYN 375 MG TABLET
NAPROXEN 500MG TABLET DELAYED-RELEASE ORAL EC-NAPROSYN 500 MG TABLET
NAPROXEN 500MG TABLET ORAL NAPROSYN 500 MG TABLET
NAPROXEN SODIUM 220MG TABLET ORAL ALEVE 220 MG TABLET
NAPROXEN SODIUM 275MG TABLET ORAL ANAPROX 275 MG TABLET
NAPROXEN SODIUM 550MG TABLET ORAL ANAPROX DS 550 MG TABLET
NAPROXEN SODIUM 550MG TABLET SA ORAL NAPRELAN 500 TABLET SA
OXAPROZIN 600MG TABLET ORAL DAYPRO 600 MG CAPLET
PIROXICAM 10MG CAPSULE ORAL FELDENE 10 MG CAPSULE
PIROXICAM 20MG CAPSULE ORAL FELDENE 20MG CAPSULE
PREDNISONE TAB 5 MG STERAPRED 5MG UNIPACK
PREDNISONE TAB 10 MG STERAPRED DS UNIPACK
SALSALATE 500MG, 750MG CAPSULE/TABLET DISALCID CAPSULE/TABLET
SULINDAC 150MG TABLET ORAL CLINORIL 150MG TABLET
SULINDAC 200MG TABLET ORAL CLINORIL 200 MG TABLET
TOLMETIN SODIUM 200MG TABLET ORAL TOLECTIN 200MG TABLET
TOLMETIN SODIUM 400MG CAPSULE ORAL TOLECTIN DS 400MG CAPSULE
TOLMETIN SODIUM 600MG TABLET ORAL TOLECTIN 600MG TABLET
SKELETAL MUSCLE RELAXANTS

PREFERRED DRUG

Reference Trade Name

BACLOFEN 10MG TABLET ORAL LIORESAL 10MG TABLET
BACLOFEN 20MG TABLET ORAL LIORESAL 20MG TABLET
CHLORZOXAZONE 250MG TABLET ORAL REMULAR-S 250MG TABLET
CHLORZOXAZONE 500MG TABLET ORAL PARAFON FORTE DSC 500MG CAPSULE
CYCLOBENZAPRINE HCL 10MG TABLET ORAL FLEXERIL 10 MG TABLET
DIAZEPAM 5 MG TABLET ORAL VALIMUM 5 MG TABLET
METHOCARBAMOL 500MG TABLET ORAL ROBAXIN 500 MG TABLET
METHOCARBAMOL 750MG TABLET ORAL ROBAXIN-750 TABLET
METHOCARBAMOL/ASPIRIN 400-325MG TABLET ORAL ROBAXISAL TABLET
ORPHENADRINE CITRATE 100MG TABLET SA ORAL NORFLEX 100 MG TABLET SA
ORPHENADRINE/ASPIRIN/CAFFEINE 25-385-30 TABLET ORAL NORGESIC TABLET
ORPHENADRINE/ASPIRIN/CAFFEINE 50-770-60 TABLET ORAL NORGESIC FORTE TABLET
TIZANIDINE HCL 2MG TABLET ORAL ZANAFLEX 2 MG TABLET
TIZANIDINE HCL 4MG TABLET ORAL ZANAFLEX 4 MG TABLET
OPOID ANALGESICS

PREFERRED DRUG

Reference Trade Name

BUTORPHANOL TARTRATE 10MG/ML SPRAY NASAL STADOL NS 10MG/ML SPRAY
CODEINE PHOS 15MG/5ML SOLUTION ORAL N/A
CODEINE PHOS 30MG TABLET SOL ORAL N/A
CODEINE PHOS 60MG TABLET SOL ORAL N/A
CODEINE PHOS/ACETAMINOPHEN 12-120MG/5 ELIXIR ORAL TYLENOL W/CODEINE ELIXIR
CODEINE PHOS/ACETAMINOPHEN 12-120MG/5 ORAL SUSP ORAL CAPITAL W/CODEINE ORAL SUSPENSION
CODEINE PHOS/ACETAMINOPHEN 15-300MG TABLET ORAL TYLENOL W/CODEINE #2 TABLET
CODEINE PHOS/ACETAMINOPHEN 30-300MG TABLET ORAL TYLENOL W/CODEINE #3 TABLET
CODEINE PHOS/ACETAMINOPHEN 30-650MG TABLET ORAL PHENAPHEN-650 W/CODEINE TABLET
CODEINE PHOS/ACETAMINOPHEN 60-300MG TABLET ORAL TYLENOL W/CODEINE #4 TABLET
CODEINE PHOS/ASPIRIN 30-325MG TABLET ORAL EMPIRIN W/CODEINE 30MG TABLET
CODEINE PHOS/ASPIRIN 60-325MG TABLET ORAL EMPIRIN W/CODEINE 60MG TABLET
CODEINE SULF 15MG TABLET ORAL N/A
CODEINE SULF 30MG TABLET ORAL N/A
CODEINE SULF 60MG TABLET ORAL N/A
CODEINE/APAP/CAFFEIN/BUTALB 30MG CAPSULE ORAL FIORICET W/CODEINE CAPSULE
CODEINE/ASA/CAFFEINE/BUTALB 30MG CAPSULE ORAL FIORINAL/CODEINE #3 CAPSULE
HYDROCODONE BIT/ACETAMINOPHEN 10-250MG TABLET ORAL STAGESIC-10 CAPLET
HYDROCODONE BIT/ACETAMINOPHEN 10-325MG TABLET ORAL NORCO 10/325 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 10-500MG TABLET ORAL LORTAB 10/500 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 10-650MG TABLET ORAL LORCET 10/650 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 10-660MG TABLET ORAL VICODIN HP TABLET
HYDROCODONE BIT/ACETAMINOPHEN 10-750MG TABLET ORAL MAXIDONE 10/750 MG TABLET
HYDROCODONE BIT/ACETAMINOPHEN 2.5-167/5 ELIXIR ORAL LORTAB ELIXIR
HYDROCODONE BIT/ACETAMINOPHEN 2.5-167/5 SOLUTION ORAL N/A
HYDROCODONE BIT/ACETAMINOPHEN 2.5-500MG TABLET ORAL LORTAB 2.5/500 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 5-325MG TABLET ORAL NORCO 5/325 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 5-500MG CAPSULE ORAL LORCET HD CAPSULE
HYDROCODONE BIT/ACETAMINOPHEN 5-500MG TABLET ORAL VICODIN 5/500 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 7.5-325MG TABLET ORAL NORCO 7.5/325 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 7.5-500MG TABLET ORAL LORTAB 7.5/500 TABLET
HYDROCODONE BIT/ACETAMINOPHEN 7.5-650MG TABLET ORAL LORCET PLUS TABLET
HYDROCODONE BIT/ACETAMINOPHEN 7.5-750MG TABLET ORAL VICODIN ES TABLET
HYDROCODONE BIT/ASPIRIN 5-500MG TABLET ORAL LORTAB ASA TABLET
HYDROMORPHONE HCL 1MG/ML LIQUID ORAL DILAUDID-5 1 MG/ML LIQUID
HYDROMORPHONE HCL 2MG TABLET ORAL DILAUDID 2 MG TABLET
HYDROMORPHONE HCL 4MG TABLET ORAL DILAUDID 4 MG TABLET
HYDROMORPHONE HCL 8MG TABLET ORAL DILAUDID 8 MG TABLET
IBUPROFEN/HYDROCODONE BIT 200-7.5MG TABLET ORAL VICOPROFEN TABLET
MEPERIDINE HCL 100MG TABLET ORAL DEMEROL 100MG TABLET
MEPERIDINE HCL 50MG TABLET ORAL DEMEROL 50 MG TABLET
MEPERIDINE HCL 50MG/5ML SYRUP ORAL DEMEROL 50 MG/5 ML SYRUP
MEPERIDINE HCL/PROMETH HCL 50-25MG CAPSULE ORAL MEPROZINE 50/25 CAPSULE
METHADONE HCL 10MG TABLET ORAL DOLOPHINE HCL 10 MG TABLET
OPIOID ANALGESICS

PREFERRED DRUG

Reference Trade Name

METHADONE HCL 10MG/5ML SOLUTION ORAL N/A
METHADONE HCL 10MG/ML ORAL CONC. ORAL METHADOSE 10 MG/ML ORAL CON
METHADONE HCL 40MG TABLET SOL ORAL METHADOSE 40 MG TABLET DISP
METHADONE HCL 5MG TABLET ORAL DOLOPHINE HCL 5 MG TABLET
METHADONE HCL 5MG/5ML SOLUTION ORAL N/A
MORPHINE SULFATE 10MG RECTAL SUPPOSITORY ROXANOL 10MG SUPPOSITORY
MORPHINE SULFATE 10MG SOLUBLE TABLET N/A
MORPHINE SULFATE 10MG/5ML SOLUTION ORAL MSIR 10 MG/5 ML ORAL SOLUTION
MORPHINE SULFATE 15MG SOLUBLE TABLET N/A
MORPHINE SULFATE 15MG TABLET ORAL MSIR 15MG TABLET
MORPHINE SULFATE 20MG RECTAL SUPPOSITORY ROXANOL 20MG SUPPOSITORY
MORPHINE SULFATE 20MG/5ML SOLUTION ORAL MSIR 20 MG/5 ML ORAL SOLUTION
MORPHINE SULFATE 20MG/ML SOLUTION ORAL ROXANOL 20 MG/ML SOLUTION
MORPHINE SULFATE 30MG RECTAL SUPPOSITORY ROXANOL 30MG SUPPOSITORY
MORPHINE SULFATE 30MG SOLUBLE TABLET N/A
MORPHINE SULFATE 30MG TABLET ORAL MSIR 30MG TABLET
MORPHINE SULFATE 5MG RECTAL SUPPOSITORY ROXANOL 5MG SUPPOSITORY
OXYCODONE HCL 15MG TABLET ORAL ROXICODONE 15 MG TABLET
OXYCODONE HCL 20MG/ML ORAL CONC. ORAL OXYFAST 20 MG/ML SOLUTION
OXYCODONE HCL 30MG TABLET ORAL ROXICODONE 30 MG TABLET
OXYCODONE HCL 5MG CAPSULE ORAL OXYIR 5 MG CAPSULE
OXYCODONE HCL 5MG TABLET ORAL ROXICODONE 5 MG TABLET
OXYCODONE HCL 5MG/5ML SOLUTION ORAL ROXICODONE 5 MG/5 ML SOLUTION
OXYCODONE HCL/ACETAMINOPHEN 10-325MG TABLET ORAL PERCOCET 10/325 MG TABLET
OXYCODONE HCL/ACETAMINOPHEN 10-650MG TABLET ORAL PERCOCET 10/650 MG TABLET
OXYCODONE HCL/ACETAMINOPHEN 2.5-325MG TABLET ORAL PERCOCET 2.5/325 MG TABLET
OXYCODONE HCL/ACETAMINOPHEN 5-325/5ML SOLUTION ORAL ROXICET 5/325 ORAL SOLUTION
OXYCODONE HCL/ACETAMINOPHEN 5-325MG TABLET ORAL PERCOCET 5/325 MG TABLET
OXYCODONE HCL/ACETAMINOPHEN 5-500MG CAPSULE ORAL TYLOX 5/500 CAPSULE
OXYCODONE HCL/ACETAMINOPHEN 7.5-325MG TABLET ORAL PERCOCET 7.5/325 MG TABLET
OXYCODONE HCL/ACETAMINOPHEN 7.5-500MG TABLET ORAL PERCOCET 7.5/500 MG TABLET
OXYCODONE/ASPIRIN 4.88-325MG TABLET ORAL PERCODAN TABLET
OXYMORPHONE HCL 5MG RECTAL SUPPOSITORY NUMORPHAN 5 MG SUPPOSITORY
PENTAZOCINE/ACETAMINOPHEN CAPLET TALACEN CAPLET
PENTAZOCINE/NALOXONE TABLET TALWIN NX TABLET
PROPOXYPHENE HCL 65MG CAPSULE ORAL DARVON 65 MG PULVULE
PROPOXYPHENE HCL/ACETAMINOPHEN 65-650MG TABLET ORAL WYGESIC 65/650 TABLET
PROPOXYPHENE HCL/ASA/CAFFEINE 32-389-32 CAPSULE ORAL DARVON COMPOUND-32 PULVULE
PROPOXYPHENE HCL/ASA/CAFFEINE 65-389 CAPSULE ORAL DARVON COMPOUND-65 PULVULE
PROPOXYPHENE NAPSYL 100MG TABLET ORAL DARVON-N 100 MG TABLET
PROPOXYPHENE/ACETAMINOPHEN 100-325MG TABLET ORAL TRYCET 100/325 MG TABLET
PROPOXYPHENE/ACETAMINOPHEN 100-650MG TABLET ORAL DARVOCET-N 100 TABLET
PROPOXYPHENE/ACETAMINOPHEN 50-325MG TABLET ORAL DARVOCET-N 50 TABLET
TRAMADOL HCL 50MG TABLET ORAL ULTRAM 50 MG TABLET
TRAMADOL HCL/ACETAMINOPHEN 37.5-325MG TABLET ORAL ULTRACET TABLET
ADJUVANTS

PREFERRED DRUG

Reference Trade Name

AMITRIPTYLINE HCL 10MG, 25MG, 50MG, 75MG, 100MG ELAVIL TABLETS
DESYREL TABLETS 50MG, 100MG TAZADONE HCL
GABAPENTIN CAPSULES 100MG, 300MG, 400MG NEURONTIN CAPSULES
NORTRIPTYLINE HCL CAPSULES 10MG, 25MG, 50MG, 75MG PAMELOR CAPSULES
 
Last Updated: Tuesday, 2-June-2009 13:34:22 EDT
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