All *MUSCULOSKELETAL THERAPY AGENTS*

Active-Cyclobenzaprine Cream 5 % Transdermal
Active-Cyclobenzaprine Cream 5 % Transdermal

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Amrix Capsule Extended Release 24 Hour 15 MG Oral
Amrix Capsule Extended Release 24 Hour 15 MG Oral

Cyclobenzaprine HCl ER

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Amrix Capsule Extended Release 24 Hour 30 MG Oral
Amrix Capsule Extended Release 24 Hour 30 MG Oral

Cyclobenzaprine HCl ER

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Baclofen Solution 10 MG/20ML Intrathecal
Baclofen Solution 10 MG/20ML Intrathecal

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Baclofen Solution 20000 MCG/20ML Intrathecal
Baclofen Solution 20000 MCG/20ML Intrathecal

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Baclofen Solution 40 MG/20ML Intrathecal
Baclofen Solution 40 MG/20ML Intrathecal

Tier: Non-Formulary
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N
Baclofen Tablet 10 MG Oral
Baclofen Tablet 10 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: N