Acetaminophen and codeine phosphate — CareFirst (Caremark)

Management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate

Initial criteria

Because of the risks of addiction, abuse, and misuse with opioids, which can occur at any dosage or duration, reserve product use for patients for whom alternative treatment options (e.g., non-opioid analgesics or combination products) have not been tolerated or are not expected to be tolerated, and have not provided adequate analgesia or are not expected to provide adequate analgesia
Use the lowest effective dose for the shortest duration consistent with individual treatment goals
Do not use for an extended period of time unless the pain remains severe enough to require an opioid analgesic and alternative options continue to be inadequate
Hydrocodone/ibuprofen should not be used for chronic pain conditions such as osteoarthritis or rheumatoid arthritis

Continuation of therapy may be considered only if the pain remains severe enough to require an opioid analgesic and alternative treatment options continue to be inadequate