Pain Medications, Topical
PDL Reference Documents
Drug Use Review Documents
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Carveout ‐ Bill FFS |
Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|---|
| 46122075355 | CAPSAICIN | capsaicin | ADH. PATCH | 0.025 % | N | Y | ||
| 70000055601 | CAPSAICIN HEAT PATCH | capsaicin | ADH. PATCH | 0.025 % | N | Y | ||
| 70512001610 | CAPSIMIDE | capsaicin | ADH. PATCH | 0.025 % | N | Y | ||
| 51824009415 | ARTHRITIS AND MUSCLE | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 50090229300 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 50488102501 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 50488102502 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 50488102505 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 52959137002 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 52959137003 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 52959137005 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 62174001429 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 69420602501 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 69420602505 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 70645002512 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 70645002525 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 70645002550 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 87701091081 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 00536252525 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | Y | ||
| 45802033010 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | Y | ||
| 45802033023 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | Y | ||
| 50268019560 | CAPSAICIN | capsaicin | CREAM (G) | 0.025 % | Y | Y | ||
| 49614041216 | MEDI-GEN | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 62436060202 | ZOSTRIX | capsaicin | CREAM (G) | 0.025 % | Y | N | ||
| 60569044202 | ZOSTRIX | capsaicin | CREAM (G) | 0.033 % | Y | N | ||
| 61787044202 | ZOSTRIX | capsaicin | CREAM (G) | 0.033 % | Y | N | ||
| 00536111825 | ARTHRITIS PAIN RELIEVING | capsaicin | CREAM (G) | 0.075 % | Y | Y | ||
| 50488107501 | CAPSAICIN | capsaicin | CREAM (G) | 0.075 % | Y | N | ||
| 52959137103 | CAPSAICIN | capsaicin | CREAM (G) | 0.075 % | Y | N | ||
| 62174005029 | CAPSAICIN | capsaicin | CREAM (G) | 0.075 % | Y | N | ||
| 85231020260 | CAPSAICIN | capsaicin | CREAM (G) | 0.075 % | Y | N | ||
| 50268019657 | CAPSAICIN | capsaicin | CREAM (G) | 0.075 % | Y | Y | ||
| 45802032903 | CAPSAICIN-HP | capsaicin | CREAM (G) | 0.075 % | Y | Y | ||
| 45802032910 | CAPSAICIN-HP | capsaicin | CREAM (G) | 0.075 % | Y | Y | ||
| 62436060102 | ZOSTRIX-HP | capsaicin | CREAM (G) | 0.075 % | Y | N | ||
| 11917006938 | ARTHRITIS PAIN RELIEF | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 11917009588 | ARTHRITIS PAIN RELIEF | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 50428034819 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 50488106006 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 73141055802 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 00536126456 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | Y | ||
| 50268019756 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | Y | ||
| 50268019842 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | Y | ||
| 70000054901 | CAPSAICIN | capsaicin | CREAM (G) | 0.1 % | Y | Y | ||
| 69375000660 | CAPSAICIN HP | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 81533020015 | CAPSAID ES | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 41167075142 | CAPZASIN-HP | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 41167075146 | CAPZASIN-HP | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 72847031620 | CAPZIX | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 60569044302 | ZOSTRIX HP | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 61787044302 | ZOSTRIX HP | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 60569055602 | ZOSTRIX HP FOOT | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 61787055602 | ZOSTRIX HP FOOT | capsaicin | CREAM (G) | 0.1 % | Y | N | ||
| 24385067746 | CAPSAICIN | capsaicin | LOTION | 0.025 % | Y | Y | ||
| 72512092000 | QUTENZA | capsaicin/skin cleanser | KIT | 8 % | N | Y | ||
| 72512092801 | QUTENZA | capsaicin/skin cleanser | KIT | 8 % | N | Y | ||
| 72512092901 | QUTENZA | capsaicin/skin cleanser | KIT | 8 % | N | Y | ||
| 72512093001 | QUTENZA | capsaicin/skin cleanser | KIT | 8 % | N | Y | ||
| 00093372750 | DICLOFENAC EPOLAMINE | diclofenac epolamine | PATCH TD12 | 1.3 % | N | Y | ||
| 00093372755 | DICLOFENAC EPOLAMINE | diclofenac epolamine | PATCH TD12 | 1.3 % | N | Y | ||
| 24208045705 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 0.1 % | Y | Y | ||
| 61314001405 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 0.1 % | Y | Y | ||
| 61314001425 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 0.1 % | Y | Y | ||
| 72888015021 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 0.1 % | Y | Y | ||
| 72888015022 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 0.1 % | Y | Y | ||
| 51672135802 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 59088037210 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 59088043510 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 65162091174 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 70512003805 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 70512081005 | DICLOFENAC SODIUM | diclofenac sodium | DROPS | 1.5 % | N | Y | ||
| 25866059361 | ALEVE ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 41163008701 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 49035026201 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 49035026935 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00113118901 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 00113118903 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 00113817501 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70677112501 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70677127701 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70677129301 | ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 63981059903 | ARTHRITIS PAIN RELIEF | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 63981059905 | ARTHRITIS PAIN RELIEF | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 70000055501 | ARTHRITIS PAIN RELIEVER | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70000055502 | ARTHRITIS PAIN RELIEVER | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70000055503 | ARTHRITIS PAIN RELIEVER | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 73581010410 | ARTHRITIS RELIEF | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 41167057100 | ASPERCREME ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 41167057302 | ASPERCREME ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 41167057303 | ASPERCREME ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 41167057304 | ASPERCREME ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 50090725000 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 57896014001 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 57896014701 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 58602060407 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 62379040101 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 63981087005 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 69842072902 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 69842097417 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 69842097435 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 69842097453 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 71205067000 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 71205074700 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 81877072310 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00536129434 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 00536129497 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 21922004409 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 43598097710 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 45802095301 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 46122075237 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 46122075252 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 46122075253 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 68001062145 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 69097052444 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 69097072044 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 69238205301 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 70512010610 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 76282010339 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 76282066339 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 83324030601 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 1 % | Y | Y | ||
| 50580057401 | MOTRIN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 50580057402 | MOTRIN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067120176 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067120282 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067293340 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815201 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815202 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815203 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815204 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815205 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815208 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00067815301 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 50090620200 | VOLTAREN ARTHRITIS PAIN | diclofenac sodium | GEL (GRAM) | 1 % | Y | N | ||
| 00472178310 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 3 % | N | Y | Pharmacy PA | |
| 45802011101 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 3 % | N | Y | Pharmacy PA | |
| 51672136307 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 3 % | N | Y | Pharmacy PA | |
| 62332058131 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 3 % | N | Y | Pharmacy PA | |
| 68462035594 | DICLOFENAC SODIUM | diclofenac sodium | GEL (GRAM) | 3 % | N | Y | Pharmacy PA | |
| 13107026947 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 21922003316 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 51672136908 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 60505040603 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 62332048712 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 65162068312 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 68180053701 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 70748033501 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 72603020701 | DICLOFENAC SODIUM | diclofenac sodium | SOL MD PMP | 20 mg/gram per actuation (2 %) | N | Y | ||
| 75987004074 | PENNSAID | diclofenac sodium | SOLN PK(G) | 2 % | N | Y | ||
| 59088080400 | LIXOFEN | diclofenac/kinesiology tape | KIT | 1.5 % | N | Y | ||
| 59088080200 | DICLOGEN | diclofenac/menthol/camphor | KIT | 1.5 %-10 %-4 % | N | Y | ||
| 83107001602 | PRAMOSONE | hydrocortisone/pramoxine | CREAM (G) | 1 %-1 % | N | Y | ||
| 83107001701 | PRAMOSONE | hydrocortisone/pramoxine | CREAM (G) | 1 %-1 % | N | Y | ||
| 00037682410 | EPIFOAM | hydrocortisone/pramoxine | FOAM | 1 %-1 % | N | Y | ||
| 83107002204 | PRAMOSONE | hydrocortisone/pramoxine | LOTION | 1 %-1 % | N | Y | ||
| 83107002002 | ANALPRAM HC | hydrocortisone/pramoxine | LOTION | 2.5 %-1 % | N | Y | ||
| 83107002102 | PRAMOSONE | hydrocortisone/pramoxine | LOTION | 2.5 %-1 % | N | Y | ||
| 83107002104 | PRAMOSONE | hydrocortisone/pramoxine | LOTION | 2.5 %-1 % | N | Y | ||
| 83107001501 | PRAMOSONE | hydrocortisone/pramoxine | OINT. (G) | 1 %-1 % | Y | |||
| 83107001401 | PRAMOSONE | hydrocortisone/pramoxine | OINT. (G) | 2.5 %-1 % | N | Y | ||
| 69557011101 | ZTLIDO | lidocaine | ADH. PATCH | 1.8 % | N | Y | Pharmacy PA | |
| 69557011130 | ZTLIDO | lidocaine | ADH. PATCH | 1.8 % | N | Y | Pharmacy PA | |
| 68001062589 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 68001062593 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 68001062595 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 70512001430 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 70512081201 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 70512081230 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 85477030210 | LIDOCAINE | lidocaine | ADH. PATCH | 4 % | N | Y | Pharmacy PA | |
| 59088090554 | DERMACINRX LIDOCAN | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090582 | DERMACINRX LIDOCAN | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090584 | DERMACINRX LIDOCAN | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00591267911 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00591267930 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00591352511 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00591352530 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00603188010 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00603188016 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088039654 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088039682 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 65162079104 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 65162079108 | LIDOCAINE | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090854 | LIDOCAN II | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090884 | LIDOCAN II | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090754 | LIDOCAN III | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090784 | LIDOCAN III | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088091054 | LIDOCAN IV | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088091084 | LIDOCAN IV | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090954 | LIDOCAN V | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 59088090984 | LIDOCAN V | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352083001 | TRIDACAINE II | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352083015 | TRIDACAINE II | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352083501 | TRIDACAINE III | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352083515 | TRIDACAINE III | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352084501 | TRIDACAINE XL | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 73352084530 | TRIDACAINE XL | lidocaine | ADH. PATCH | 5 % | N | Y | Pharmacy PA | |
| 00168020437 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 16714087801 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 16714087802 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 33342040530 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 33342040535 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 33342040550 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 51672300803 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 51672300805 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 51672302002 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 51672302009 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 62332042430 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 62332042435 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 62332042450 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 65162091838 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 65162091853 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 67877047379 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 67877047380 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 68462041820 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 68462041827 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 69680012035 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 70752011303 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 70752011304 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 71085001150 | LIDOCAINE | lidocaine | OINT. (G) | 5 % | Y | Y | ||
| 70512001230 | LIDAFLEX | lidocaine HCl | ADH. PATCH | 4 % | N | Y | ||
| 59088024107 | DERMACINRX LIDOCAINE | lidocaine HCl | CREAM (G) | 3 % | Y | Y | ||
| 69367020201 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 3 % | Y | Y | ||
| 69367020285 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 3 % | Y | Y | ||
| 59088037107 | LIDOTRAL | lidocaine HCl | CREAM (G) | 3.88 % | N | Y | ||
| 46122061410 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 70000009801 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 73352020460 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 83035113003 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 83324000627 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 87137010107 | LIDOCAINE HCL | lidocaine HCl | CREAM (G) | 4 % | N | Y | ||
| 70000053701 | BURN RELIEF | lidocaine HCl | GEL (GRAM) | 1 % | Y | |||
| 59088022103 | LIDOEASE | lidocaine HCl | GEL (GRAM) | 2 % | N | Y | ||
| 59088022107 | LIDOEASE | lidocaine HCl | GEL (GRAM) | 2 % | N | Y | ||
| 85477030685 | TOPICAINE | lidocaine HCl | GEL (GRAM) | 2 % | N | Y | ||
| 85477030785 | TOPICAINE ULTRA | lidocaine HCl | GEL (GRAM) | 2 % | N | Y | ||
| 59088046607 | DERMACINRX LIDOGEL | lidocaine HCl | GEL (GRAM) | 2.8 % | N | Y | ||
| 59088047507 | DERMACINRX LIDOREX | lidocaine HCl | GEL (GRAM) | 2.8 % | N | Y | ||
| 73352062001 | TRILOGEL | lidocaine HCl | GEL (GRAM) | 2.8 % | N | Y | ||
| 25021067376 | GLYDO | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 25021067377 | GLYDO | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 76329301105 | LIDOCAINE HCL | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 76329301205 | LIDOCAINE HCL | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 76329301305 | LIDOCAINE HCL | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 76329301505 | LIDOCAINE HCL | lidocaine HCl | JEL/PF APP | 2 % | Y | Y | ||
| 72485061110 | LIDOCAINE HCL | lidocaine HCl | JELLY(ML) | 2 % | N | Y | ||
| 72485061130 | LIDOCAINE HCL | lidocaine HCl | JELLY(ML) | 2 % | N | Y | ||
| 72485061131 | LIDOCAINE HCL | lidocaine HCl | JELLY(ML) | 2 % | N | Y | ||
| 54859051302 | DOLOGESIC PAIN RELIEF | lidocaine HCl | LIQD ROLON | 4 % | N | Y | ||
| 70000009901 | LIDOCAINE | lidocaine HCl | LIQD ROLON | 4 % | N | Y | ||
| 59651094301 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 00054350049 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 00121095003 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 00121495015 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 00121495040 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 60687087044 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 60687087050 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 60687087064 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 62135071242 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 72888012526 | LIDOCAINE HCL VISCOUS | lidocaine HCl | SOLUTION | 2 % | Y | Y | ||
| 00054350547 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 00116402550 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 00121097251 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 00527600480 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 51672141103 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 63739099764 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 70954051810 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 76329630005 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 83148004350 | LIDOCAINE HCL | lidocaine HCl | SOLUTION | 40 mg/mL | Y | Y | ||
| 69367039701 | LIDOCAINE-HYDROCORTISONE | lidocaine/hydrocortisone ac | CREAM (G) | 3 %-0.5 % | N | Y | ||
| 69367039785 | LIDOCAINE-HYDROCORTISONE | lidocaine/hydrocortisone ac | CREAM (G) | 3 %-0.5 % | N | Y | ||
| 59088043005 | LIDOCORT | lidocaine/hydrocortisone ac | CREAM (G) | 3 %-0.5 % | N | Y | ||
| 59088073100 | XYLIDERM | lidocaine/kinesiology tape | KIT | 5 % | N | Y | ||
| 00121100230 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00168035705 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00168035730 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00168035755 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00574204205 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00574204213 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00574204230 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 21922007605 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 62332058204 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 62332058231 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 72578016506 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 81033002501 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 81033002505 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 81033002550 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 81033002551 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | CREAM (G) | 2.5 %-2.5 % | Y | Y | ||
| 00168035756 | LIDOCAINE-PRILOCAINE | lidocaine/prilocaine | KIT | 2.5 %-2.5 % | N | Y | ||
| 71085010030 | PLIAGLIS | lidocaine/tetracaine | CREAM (G) | 7 %-7 % | N | Y |