All *ANALGESICS - NonNarcotic*

7T Gummy ES Tablet Chewable 500 MG Oral
7T Gummy ES Tablet Chewable 500 MG Oral

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution 10 MG/ML Intravenous
Acetaminophen Solution 10 MG/ML Intravenous

Tier: 1
PA Type: No Prior Authorization
ST: N
Acetaminophen Solution Prefilled Syringe 100 MG/10ML Intravenous
Acetaminophen Solution Prefilled Syringe 100 MG/10ML Intravenous

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Allzital Tablet 25-325 MG Oral
Allzital Tablet 25-325 MG Oral

Butalbital-Acetaminophen

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N