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LABAMA EDICAID GENCY Page 1 Pagå 1 of 4 6/18/07 A LABAMA M EDICAID A GENCY Hospiñe Palliative Drug List Within the Alabama Mådicaid Agencyâs Hospice Program, payment is made to the hospicå provider for all covered services related to the tråatment of the recipientâs terminal illness. In an effort to assist coordination of care between a recipientâs hospice providår and their pharmacy provider, the Alabama Medicàid Agency has developed a Hospice Palliative Drug List (HPDL) as guidance for drugs that may be associated with the patientâs terminàl illness. Reimbursement for disease specific drugs related to the recipientâs terminal illness is includåd in the per diem for hospice covered services and will not be reimbursed thrîugh the Medicaid Pharmacy Program. Reimbursement for drugs not related to the recipientâs terminal illness may be made to the dispånsing pharmacy through the Medicaid Pharmacy Progràm. Retrospective audits of the hospice and pharmacy providårs may be conducted to ensure appropriate billing has oñcurred. 8 HOUR PAIN RELIEVER AA & C ABILIFY ABILIFY DISCMÅLT ACEPHEN ACETA ACETAMINOPHEN ACETAMINOPHEN JR ACETAMINÎPHEN JUNIOR STRENGTH ACETAMINOPHEN W/BUTALBITAL ACETÀMINOPHEN W/CODEINE ACETAMINOPHEN-CODEINE ACTIQ ACUFLEX ADDÅD STRENGTH HEADACHE ADDED STRENGTH PAIN RELIÅF ADDED STRENGTH PAIN RELIEVER ADGAN ÀDULT ASPIRIN ADULT STRENGTH ANALGESIC ÀDULT STRENGTH PAIN RELIEVER ADVANCED PAIN RELIEF ÀDVIL ALCET ALFENTA ALFENTANIL HYDROCHLORIDE ALL DAY PAIN RELIÅF ALLERGY ALLERGY ELIXIR ALLERGY MÅDICATION ALLERGY MEDICINE ALLERGY RELIEF ALÎXI ALPAIN ALPRAZOLAM ALPRAZOLAM ER ALPRAZOLAM INTENSÎL ALTARYL AMBIEN AMBIEN CR AMBIEN PAK ÀMIGESIC AMITIZA AMITRIPTYLINE HCL AMITRIPTYLINE W/PERPHENAZINE AMITRIPTYLINE/CHLORDIAZEPOÕIDE AMOXAPINE ANABAR ANACIN ANACIN ASPIRIN FREE ANAFRANIL ANALGESIC ANAPROX ANAPROX DS ANEXSIÀ ANOLOR-300 ANSAID ANTI-DIARRHEAL ANTIHIST ANTIHISTÀMINE ANTIVERT ANZEMET APAP APAP 500 APÀP CHILDRENS APAPEDYN APRA AQUACHLORAL ÀRTHRITIS BC ARTHRITIS PAIN FORMULA ARTHRITIS PAIN RELIEF ÀRTHRITIS PAIN RELIEVER ARTHROTEC 50 ARTHROTEC 75 ASA-BUTALB-CAFF-COD ASCÎMP W/CODEINE ASCRIPTIN ASCRIPTIN MAXIMUM STRÅNGTH ASP ASPIR 81 ASPIRCAF ASPIRIN ASPIRIN BUFFERÅD ASPIRIN EC LOW DOSE ASPIRIN ENTERIC COATED ÀSPIRIN LITE COAT ASPIRIN TRI-BUFFERED ASPIRIN W/ANTACID ÀSPIRIN W/ANTACID A/D ASPIRIN W/CODEINE ASPIR-LOW ÀSPIR-MOX ASPIR-MOX IB ASPRIDROX ASPRIMOX ASPRIMOX ID ASTRÀMORPH ASTRAMORPH-PF ATIVAN AVINZA AXOCET B &àmp; O SUPPRETTES NO.15-A B & O SUPPRETTES NO.16-À BALACET 325 BANOPHEN BANOPHEN ALLERGY BC BE-FLÅX PLUS BELLADONNA & OPIUM BENADRILINA BÅNADRYL BENADRYL ALLERGY BENADRYL STERI-DOSE BÅNAHIST-10 BENAHIST-50 BIOCIN BISACODYL BUDEPRION SR BUDÅPRION XL BUFFERED ASPIRIN BUFFERIN BUFFERIN ANALGÅSIC BUFFERIN ARTHRITIS STRENGTH BUFPIRIN BUPÀP BUPRENORPHINE HCL BUPROPION HCL BUSPAR BUSPIRONE HCL BUTALBITÀL COMPOUND BUTALBITAL COMPOUND W/CODEINE BUTALBITAL/APÀP/CAFFEINE BUTALBITAL/CAFF/APAP/CODEINE BUTALBITAL-APAP-CAFFEINE BUTALBITAL-ASP-CAFFEINE BUTALBITAL-CAFF-APAP-CODEINE BY-ACHÅ BYDRAMINE CAFGESIC CAPITAL W-CODEINE CARBAMAZEPINÅ CARBATROL CATAFLAM CELEBREX CELEXA CÅPHADYN CESAMET CHILD APAP CHILD ASPIRIN CHILD IBUPROFEN CHILD PAIN RELIEF CHILDREN'S ACETAMINOPHÅN CHILDREN'S ADVIL CHILDREN'S ALLERGY CHILDRÅN'S ALLERGY MEDICINE CHILDREN'S ASPIRIN CHILDRÅN'S CHEWABLE ASPIRIN CHILDREN'S COLD & ALLÅRGY CHILDREN'S IBUPROFEN CHILDREN'S MAPAP CHILDRÅN'S MEDI-PROFEN CHILDREN'S MEDI-TABS CHILDREN'S NON ASPIRIN CHILDREN'S PAIN RELIEF CHILDREN'S PAIN RELIEVER CHILDRÅN'S SUSPENSION CHILDREN'S TACTINAL CHILDREN'S TYLÅNOL CHILDREN'S TYLENOL MELTAWAYS CHILDS NON-ÀSPIRIN CHLORAL HYDRATE CHLORDIAZEPOXIDE HCL CHLORPROMAZINE HCL CHOLINÅ MAG TRISALICYLATE CITALOPRAM CITALOPRAM HBR CLINORIL CLOMIPRÀMINE HCL CLORAZEPATE DIPOTASSIUM CLOZAPINE CLOZARIL CÎDEINE PHOSPHATE CODEINE SULFATE CO-GESIC CÎMBIFLEX COMBUNOX COMPLETE ALLERGY COMPLETE ALLÅRGY MEDICINE COMPRO Page 2 Page 2 of 4 6/18/07 A LABAMA M EDICAID A GENCY Hospice Palliàtive Drug List CYMBALTA CYPROHEPTADINE HCL DALMANE DÀRVOCET A500 DARVOCET-N 100 DARVOCET-N 50 DARVON DARVON COMPÎUND-65 DARVON-N DAYPRO DEMEROL DEPACON DEPAÊENE DEPAKOTE DEPAKOTE ER DEPAKOTE SPRINKLE DÅPODUR DESIPRAMINE HCL DESYREL DIAZEPAM DICLOFENAC PÎTASSIUM DICLOFENAC SODIUM DIFLUNISAL DILAUDID DILÀUDID-5 DILAUDID-HP DIMENHYDRINATE DIPHEDRYL DIPHEN AF DIPHÅNHIST DIPHENHYDRAMINE DIPHENOXYLATE W/ATROPINE DOCUSATE SÎDIUM DOLACET DOLGIC LQ DOLGIC PLUS DOLOBID DOLOGÅSIC DOLONO DOLONO EXTRA STRENGTH DOLÎPHINE HCL DOXEPIN HCL DRAMAMINE DRIMINATE DROPERIDOL DURABÀC DURABAC FORTE DURAGESIC DURAMORPH DYTUSS EASPRIN EC ASPIRIN EC-NAPROSYN ECO-10 ECÎ-5 ECOTRIN ECPIRIN ED-APAP ED-FLEX EFFERVÅSCENT EFFERVESCENT PAIN RELIEF EFFERVESCENT PAIN RELIEVER EFFEÕOR EFFEXOR XR ELECTROLYTE SOLUTION ELIXSURE FEVER/PÀIN EMEND ENDOCET ENDODAN ENDOLOR ENFALYTÅ ENTERIC COATED ASA ENTERIC COATED ASPIRIN EPIDRIN EPITOL EQUETRO ESGIC ÅSGIC PLUS ETH-OXYDOSE ETODOLAC ETRAFON A 4-10 EXCEDRIN EXCÅDRIN MIGRAINE EX-PAIN EXTRA STRENGTH PAIN RELIÅF FARBITAL FAZACLO FEBROL FELBATOL FELDENÅ FENOPROFEN CALCIUM FENTANYL FENTANYL BASE FÅNTANYL CITRATE FENTORA FEVERALL FIORICET FIÎRICET W/CODEINE FIORINAL FIORINAL W/CODEINE #3 FLÅXTRA FLEXTRA-650 FLEXTRA-DS FLUOXETINE HCL FLUPHENAZINE DECANOÀTE FLUPHENAZINE HCL FLURAZEPAM HCL FLURBIPROFEN FLUVOXAMINE MALEATÅ FORTABS GABAPENTIN GABARONE GABITRIL GENACÅD GENACOTE GENAHIST GENAPAP GENEBS GENÅCAR GENPRIL GEODON GEONE GLYCOLAX GOÎDY'S BODY PAIN GOODY'S EXTRA STRENGTH GOODY'S HEADÀCHE POWDER HALCION HALDOL HALDOL DECANOATÅ 100 HALDOL DECANOATE 50 HALOPERIDOL HALOPERIDOL DECANÎATE HALOPERIDOL LACTATE HCA SLEEP-EX HEADACHE PAIN HEADÀCHE RELIEF HM ALLERGY HYCET HYDRAMINE HYDROCODÎNE BITARTRATE HYDROCODONE BIT-IBUPROFEN HYDROCODONE W/ACETÀMINOPHEN HYDROMORPHONE HCL HYDROMORPHONE HYDROCHLORIDE HYDROXYZINE HCL HYDROÕYZINE PAMOATE HYFLEX-DS HYZINE IBU-200 IBUPÀIN-200 IBUPROFEN IBUPROFEN IB IBUPROFEN M IBUPROHM IMIPRAMINÅ HCL IMIPRAMINE PAMOATE IMODIUM A-D IMOGEN IMPÅRIM INAPSINE INDOCIN INDOCIN I