use of high risk medications in the elderly (dae)...november 2012 1 centers for medicare &...

424
November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS IN THE ELDERLY” MEASURE IN THE 2011 INDIVIDUAL PHYSICIAN QRUR REPORTS Document Length: 424 Pages Overview Measure Description The percentage of patients 65 years of age and older who received at least one high-risk medication. The percentage of patients 65 years of age and older who received at least two different high-risk medications. Deviations from HEDIS Specifications The denominator from the third-party specifications includes beneficiaries who have “continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the measurement year.” The common enrollment specifications (and exclusion of 2011 part year beneficiaries) mean that all beneficiaries in the denominator will have enrollment for all of 2011. Also, the allowed gap of 45 days for HEDIS specs is different from the one-month gap allowed in our specs. The third-party specifications do not specify the setting for the NDC codes, but there are no NDC codes on claims other than Part D so we only search Part D claims. Assumptions/Notes The measurement year is 2011. Measure denominator requires continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the measurement year. Note that Mathematica’s enrollment pre-processing has already occurred, so this requirement will be met for Parts A and B since part year beneficiaries from 2011 will be previously dropped. The look-back period for all claims-based quality measures is no more than 1 year. These specs are based on the HEDIS 2011 EP specs, even though the 2010 version is the NQF endorsed version. There are no substantive differences between the 2010 and 2011 specs, so the 2011 specs were used. The name used by NCQA is different than the name used by Mathematica (“drugs to be avoided in the elderly”); NCQA has named it differently because there are certain cases where the drugs should be used. Data Sources Denominator inclusion data: 2011 Part A file 2011 Part B file 2011 Part D file Denominator exclusion data: None Numerator inclusion data: 2011 Part D file

Upload: others

Post on 26-Sep-2020

5 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

November 2012 1 Centers for Medicare & Medicaid Services

MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS IN THE ELDERLY” MEASURE IN THE 2011 INDIVIDUAL PHYSICIAN QRUR REPORTS

Document Length: 424 Pages

Overview

Measure Description

• The percentage of patients 65 years of age and older who received at least one high-risk medication.

• The percentage of patients 65 years of age and older who received at least two different high-risk medications.

Deviations from HEDIS Specifications

• The denominator from the third-party specifications includes beneficiaries who have “continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the measurement year.” The common enrollment specifications (and exclusion of 2011 part year beneficiaries) mean that all beneficiaries in the denominator will have enrollment for all of 2011. Also, the allowed gap of 45 days for HEDIS specs is different from the one-month gap allowed in our specs.

• The third-party specifications do not specify the setting for the NDC codes, but there are no NDC codes on claims other than Part D so we only search Part D claims.

Assumptions/Notes

• The measurement year is 2011.

• Measure denominator requires continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to 45 days during the measurement year. The patient must be enrolled as of December 31 of the measurement year. Note that Mathematica’s enrollment pre-processing has already occurred, so this requirement will be met for Parts A and B since part year beneficiaries from 2011 will be previously dropped.

• The look-back period for all claims-based quality measures is no more than 1 year.

• These specs are based on the HEDIS 2011 EP specs, even though the 2010 version is the NQF endorsed version. There are no substantive differences between the 2010 and 2011 specs, so the 2011 specs were used. The name used by NCQA is different than the name used by Mathematica (“drugs to be avoided in the elderly”); NCQA has named it differently because there are certain cases where the drugs should be used.

Data Sources

Denominator inclusion data:

• 2011 Part A file • 2011 Part B file • 2011 Part D file

Denominator exclusion data: • None

Numerator inclusion data:

• 2011 Part D file

Page 2: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

November 2012 2 Centers for Medicare & Medicaid Services

Denominator

Beneficiaries are included in the denominator if the following criteria are met:

• 65 years and older as of December 31 of the measurement year

• Continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of up to one month during the measurement year

Enrolled as of December 31 of the measurement

Rate Calculations

For both rates, a lower rate represents better performance.

Page 3: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

November 2012 3 Centers for Medicare & Medicaid Services

Technical Specifications

Denominator

The eligible population of beneficiaries who were a) 65 years and older as of December 31 of the measurement year and b) have continuous medical and pharmacy benefit enrollment for the measurement year with no more than one gap in enrollment of one month during the measurement year. The patient must be enrolled in Parts A, B, and D in December of the measurement year.

A. For each beneficiary attributed to a provider use the enrollment arrays created in the enrollment pre-processing program and create NCQA_HRME_DEN = 1 if:

1. 65 <= Years between BENE_DOB and 12/31/2011 and

The sum of the Part A, B, and D enrollment flags in each month of 2011 is less than 3 in no more than one month. The sum of the flags in December 2011 must be equal to 3.

Denominator Exclusions

None

Numerator

Numerator 1 - At least one prescription dispensed for any high-risk medication (Appendix A) during the measurement year.

1. For each beneficiary, create NCQA_HRME1_NUM variable

2. Search the 2011 Part D File and flag beneficiaries for inclusion in the numerator.

2.1. NCQA_HRME1_NUM = 1 if

2.2. The beneficiary was dispensed at least one of the drugs identified in Appendix A between 1/1/2011 and 12/31/2011.

3. Else NCQA_HRME1_NUM = 0

Numerator 2 - At least two prescriptions dispensed for different high-risk medications (Drug ID column in Appendix A) during the measurement year.

4. For each beneficiary, create NCQA_HRME2_NUM variable

5. Search the 2011 Part D File and flag beneficiaries for inclusion in the numerator.

5.1. NCQA_HRME2_NUM = 1 if

5.2. The beneficiary was dispensed at least two different drugs identified in the Drug ID column of Appendix A between 1/1/2011 and 12/31/2011.

Else NCQA_HRME2_NUM = 0

Page 4: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

November 2012 4 Centers for Medicare & Medicaid Services

Provider Performance Measure

A. For each provider, create

B. For each provider, create

Page 5: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60569047104 Diabetic Tussin Night Time Formula acetaminophen/dextromethorphan/diphenhydrAMINE 325 mg-10 mg-12.5 mg/5 mL oral liquid

oral antihistamines d05495

61787047104 Diabetic Tussin Night Time Formula acetaminophen/dextromethorphan/diphenhydrAMINE 325 mg-10 mg-12.5 mg/5 mL oral liquid

oral antihistamines d05495

00031873512 Robitussin Nighttime Multi-Symptom Cold

acetaminophen/diphenhydrAMINE/phenylephrine 160 mg-6.25 mg-2.5 mg/5 mL oral liquid

oral antihistamines d05654

00031873518 Robitussin Nighttime Multi-Symptom Cold

acetaminophen/diphenhydrAMINE/phenylephrine 160 mg-6.25 mg-2.5 mg/5 mL oral liquid

oral antihistamines d05654

12547017585 Benadryl Allergy & Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

12547017586 Benadryl Allergy & Sinus Headache acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

12547017588 Benadryl Allergy & Sinus Headache acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

12547022733 Sudafed PE Severe Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

12547022734 Sudafed PE Severe Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

50580066412 Sudafed PE Severe Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

50580066424 Sudafed PE Severe Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg oral tablet

oral antihistamines d05654

00043046008 Theraflu Warming Severe Cold Nighttime acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 mL oral syrup

oral antihistamines d05654

00043626508 Theraflu Warming Flu & Sore Throat acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 mL oral syrup

oral antihistamines d05654

00067640708 Theraflu Warming Sinus & Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 mL oral syrup

oral antihistamines d05654

49348090470 Flu Relief Therapy Nighttime acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-12.5 mg-5 mg/15 mL oral syrup

oral antihistamines d05654

00501290720 Sudafed PE Nighttime Cold acetaminophen/diphenhydrAMINE/phenylephrine 325 mg-25 mg-5 mg oral tablet

oral antihistamines d05654

Page 6: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00043625606 Theraflu Severe Cold & Cough Nighttime acetaminophen/diphenhydrAMINE/phenylephrine 650 mg-25 mg-10 mg oral powder for reconstitution

oral antihistamines d05654

49348020604 Allergy/Sinus Headache acetaminophen/diphenhydrAMINE/pseudoephedrine 500 mg-12.5 mg-30 mg oral tablet

oral antihistamines d04168

00501203020 Benadryl Severe Allergy & Sinus Headache

acetaminophen/diphenhydrAMINE/pseudoephedrine 500 mg-25 mg-30 mg oral tablet

oral antihistamines d04168

00501275220 Sudafed Sinus Nighttime Plus Pain acetaminophen/diphenhydrAMINE/pseudoephedrine 500 mg-25 mg-30 mg oral tablet

oral antihistamines d04168

12547017050 Benadryl Cold acetaminophen/diphenhydrAMINE/pseudoephedrine 500 mg-25 mg-30 mg oral tablet

oral antihistamines d04168

00135000945 Contac Day and Night Allergy acetaminophen/diphenhydrAMINE/pseudoephedrine oral tablet oral antihistamines d04168

50580025208 Tylenol Cold Relief Nighttime acetaminophen-diphenhydrAMINE 1000 mg-50 mg/30 mL oral liquid

oral antihistamines d03445

50580042708 Tylenol PM acetaminophen-diphenhydrAMINE 1000 mg-50 mg/30 mL oral liquid

oral antihistamines d03445

50580081408 Tylenol Sore Throat Nighttime acetaminophen-diphenhydrAMINE 1000 mg-50 mg/30 mL oral liquid

oral antihistamines d03445

63029005004 Percogesic Original Strength acetaminophen-diphenhydrAMINE 325 mg-12.5 mg oral tablet oral antihistamines d03445

75137000493 Percogesic Original Strength acetaminophen-diphenhydrAMINE 325 mg-12.5 mg oral tablet oral antihistamines d03445

75137000495 Percogesic Original Strength acetaminophen-diphenhydrAMINE 325 mg-12.5 mg oral tablet oral antihistamines d03445

75137090492 Percogesic Original Strength acetaminophen-diphenhydrAMINE 325 mg-12.5 mg oral tablet oral antihistamines d03445

00085111701 Coricidin Night Time Cold Relief acetaminophen-diphenhydrAMINE 325 mg-12.5 mg/15 mL oral liquid

oral antihistamines d03445

00045021148 Tylenol Severe Allergy Caplet acetaminophen-diphenhydrAMINE 500 mg-12.5 mg oral tablet oral antihistamines d03445

49348077904 Allergy Severe Multi-Symptom acetaminophen-diphenhydrAMINE 500 mg-12.5 mg oral tablet oral antihistamines d03445

Page 7: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50580023324 Tylenol Cold Relief Caplet acetaminophen-diphenhydrAMINE 500 mg-12.5 mg oral tablet oral antihistamines d03445

50580023348 Tylenol Cold Relief Caplet acetaminophen-diphenhydrAMINE 500 mg-12.5 mg oral tablet oral antihistamines d03445

75137000497 Percogesic Extra Strength acetaminophen-diphenhydrAMINE 500 mg-12.5 mg oral tablet oral antihistamines d03445

00045018210 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00045024420 Tylenol Extra Strength PM Rapid Release Gelcaps

acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00045024440 Tylenol Extra Strength PM Rapid Release Gelcaps

acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00045024480 Tylenol Extra Strength PM Rapid Release Gelcaps

acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00045048220 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00045048235 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00113035571 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00122087866 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00247223600 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00247223650 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00280807020 Midol PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00363023506 Acetaminophen PM Extra Strength acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00363023515 Acetaminophen PM Extra Strength acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

Page 8: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00363024615 Acetaminophen PM Extra Strength acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00363036050 Acetaminophen PM Extra Strength acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00536347906 Acetaminophen-DiphenhydrAMINE Hydrochloride

acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00573031510 Anacin P.M. Aspirin Free acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00904761651 Mapap PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00904765151 Mapap PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135035201 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135035213 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135035250 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135035255 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135035257 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

10135041055 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

12843016521 Midol PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

24385043771 Pain Reliever and Sleep Aid PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

37205006071 Pain Reliever and Sleep Aid PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348007309 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

Page 9: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49348029209 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348034854 Non-Aspirin PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348034909 Non-Aspirin PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348034910 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348034954 Non-Aspirin PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348061109 Headache Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348091809 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

49348091810 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017604 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017608 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017610 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017614 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017615 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017624 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017650 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580017670 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

Page 10: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50580017674 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580018220 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580018240 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580018252 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580023424 Tylenol Cold Relief Nighttime Caplet acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580024420 Tylenol Extra Strength PM Rapid Release Gelcaps

acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580042610 Tylenol Extra Strength PM Vanilla Caplet acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580042623 Tylenol Extra Strength PM Vanilla Caplet acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580042624 Tylenol Extra Strength PM Vanilla Caplet acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048210 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048215 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048224 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048226 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048235 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048245 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

50580048250 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

Page 11: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50580048270 Tylenol Extra Strength PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

51645070905 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

57896022401 Night Time Pain acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

57896022405 Night Time Pain acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

65162060824 Acetaminophen PM acetaminophen-diphenhydrAMINE 500 mg-25 mg oral tablet oral antihistamines d03445

00067205308 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205324 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205350 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205391 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205524 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205550 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067205591 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067640520 Excedrin PM Express Gels acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

00067640580 Excedrin PM Express Gels acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

01981000323 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

01981000325 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

Page 12: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

01981000326 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

01981007634 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

01981007643 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000156 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000182 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000183 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000240 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000322 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000323 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810000326 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810001801 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810001802 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810001803 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810001804 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810003202 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810003203 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

Page 13: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

19810003206 Excedrin PM Caplet acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810007067 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

19810007068 Excedrin PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

49348007209 Pain Relief PM acetaminophen-diphenhydrAMINE 500 mg-38 mg oral tablet oral antihistamines d03445

21406049050 Legatrin PM acetaminophen-diphenhydrAMINE 500 mg-50 mg oral tablet oral antihistamines d03445

21406049130 Legatrin PM acetaminophen-diphenhydrAMINE 500 mg-50 mg oral tablet oral antihistamines d03445

74300000366 Unisom with Pain Relief acetaminophen-diphenhydrAMINE 650 mg-50 mg oral tablet oral antihistamines d03445

74300000367 Unisom with Pain Relief acetaminophen-diphenhydrAMINE 650 mg-50 mg oral tablet oral antihistamines d03445

00024193704 Talacen acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

00247103890 Talacen acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

00591039601 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

21695063460 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

52152021302 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

52959052300 Talacen acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

55045303708 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

55289088915 Talacen acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

58016046100 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

58016046120 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

58016046130 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

58016046160 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

58016046190 Acetaminophen-Pentazocine acetaminophen-pentazocine 650 mg-25 mg oral tablet oral narcotics d03682

Page 14: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247144101 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00247144104 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00247144105 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00247144120 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00378013001 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00378013005 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00591071401 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00591071405 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00603546221 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

00603546228 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

16590019615 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

16590019620 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

16590019630 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

51079074101 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

51079074120 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

52959016520 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

Page 15: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959016530 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

54569258800 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

54569258801 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

54868364600 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

55289032130 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027900 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027902 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027910 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027912 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027915 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027920 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027925 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027930 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027940 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027950 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027960 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

Page 16: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016027970 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027980 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

58016027990 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

68115081500 Acetaminophen-Propoxyphene Hydrochloride

acetaminophen-propoxyphene hydrochloride 650 mg-65 mg oral tablet

oral narcotics d03434

10122030110 Balacet acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

24486032510 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

35356050730 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

35356050760 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

35356050790 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

55045341900 Balacet acetaminophen-propoxyphene napsylate 325 mg-100 mg oral tablet oral narcotics d03434

00247061120 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-50 mg oral tablet oral narcotics d03434

00603546521 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 325 mg-50 mg oral tablet oral narcotics d03434

66479051410 Darvocet-N 50 acetaminophen-propoxyphene napsylate 325 mg-50 mg oral tablet oral narcotics d03434

24486032610 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

50111079001 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

54868514700 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

Page 17: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868551700 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

55045333500 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

55045333501 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

58016015000 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

58016015030 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

58016015060 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

58016015090 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

66479051310 Darvocet A500 acetaminophen-propoxyphene napsylate 500 mg-100 mg oral tablet oral narcotics d03434

00093049001 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00093049005 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00093089001 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00093089005 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00228208510 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008600 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008602 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008603 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 18: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247008604 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008605 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008606 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008608 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008610 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008612 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008615 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008616 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008620 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008624 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008625 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008628 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008630 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008640 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008645 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008650 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 19: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247008659 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008660 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008677 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008690 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247008698 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081804 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081812 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081815 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081820 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081825 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247081830 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00247212400 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00378015501 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00378015505 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406172101 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406172105 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 20: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00406172110 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406172191 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177201 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177205 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177210 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177233 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177262 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00406177291 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00440821010 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546621 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546628 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546632 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546716 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546721 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546728 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546732 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 21: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603546802 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546804 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546816 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546819 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546821 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546822 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546828 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00603546832 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00904228060 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00904228140 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00904228160 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00904770280 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

10544030230 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019715 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019728 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019730 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 22: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590019740 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019745 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019760 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019772 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019775 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

16590019790 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012815 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012828 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012830 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012840 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012850 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012860 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012890 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

18837012898 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028008 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028012 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 23: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

21695028015 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028020 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028028 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028030 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028060 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028072 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

21695028090 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490012003 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490012006 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619700 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619701 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619702 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619703 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619704 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619705 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619707 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 24: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490619708 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490619709 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490793004 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490793007 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

23490793008 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

33358030801 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

33358030860 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

43063002306 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

43353046730 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

43353046830 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076700 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076701 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076706 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076710 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076712 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076715 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 25: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999076720 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076730 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076750 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076760 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

49999076790 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032201 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032220 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032221 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032230 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032256 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032296 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51079032299 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083724 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083725 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083726 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083751 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 26: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51655083752 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083753 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083754 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083777 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

51655083782 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959018820 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033500 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033502 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033510 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033512 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033514 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033515 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033520 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033521 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033524 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033525 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 27: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959033528 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033530 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033535 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033536 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033540 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033542 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033545 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033550 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033560 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033580 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033584 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

52959033590 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569000702 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569000703 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001500 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001501 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 28: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569001502 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001503 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001504 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001505 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001506 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001507 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001508 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569001509 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569329200 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569329201 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569329202 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569329204 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569329205 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54569508201 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54868067600 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54868067602 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 29: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868067603 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

54868067663 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045112700 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045112702 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045112703 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045112708 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045112709 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299900 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299902 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299903 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299904 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299905 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299907 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299908 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045299909 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045309500 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 30: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045309501 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045309509 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337700 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337701 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337703 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337704 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337705 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55045337709 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289023104 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289023108 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289023112 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289023116 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289023140 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289085210 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289085212 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55289085220 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 31: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887094301 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094310 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094312 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094314 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094315 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094320 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094324 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094325 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094330 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094340 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094350 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094360 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094382 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

55887094390 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436101 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436102 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 32: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

57866436103 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436104 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436105 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436106 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

57866436109 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016005600 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016005630 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016005660 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016005690 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021200 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021202 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021203 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021208 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021210 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021212 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021214 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 33: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016021215 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021216 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021218 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021220 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021221 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021224 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021228 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021230 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021236 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021240 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021242 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021245 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021250 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021256 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021260 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021273 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 34: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016021280 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021284 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021289 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021290 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021292 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58016021299 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

58864042820 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

60760089015 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

60760089030 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

60760089060 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

61392044610 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

61392044615 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

61392044645 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

61392044656 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134401 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134402 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 35: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63629134403 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134404 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134405 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134406 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134407 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134408 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63629134409 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63739021501 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63739021503 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63739021510 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63739021515 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020101 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020103 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020104 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020105 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020108 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 36: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874020110 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020112 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020114 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020115 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020116 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020118 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020120 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020121 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020124 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020125 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020128 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020130 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020135 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020136 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020140 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020142 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 37: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874020145 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020148 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020150 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020156 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020160 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020171 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020172 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020174 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020177 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020180 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020184 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874020190 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874021220 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

63874021230 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017806 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017812 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 38: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267017815 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017820 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017830 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017840 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017850 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017860 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017890 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66267017891 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336061020 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336061030 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062810 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062812 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062815 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062816 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062820 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66336062830 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 39: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336062860 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66479051510 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66479051550 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66591064141 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

66591064151 Darvocet-N 100 acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

67544003330 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

67544013830 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

67544015130 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

67544049730 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68084039301 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030500 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030520 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030525 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030530 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030540 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030560 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

Page 40: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115030590 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68115030599 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010001 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010012 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010015 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010030 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010040 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010050 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010060 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

68387010090 Acetaminophen-Propoxyphene Napsylate acetaminophen-propoxyphene napsylate 650 mg-100 mg oral tablet oral narcotics d03434

00187380510 Limbitrol amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

00378021101 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

00378021105 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

00904170040 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

00904170060 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

49884096101 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

Page 41: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569017300 Limbitrol amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

54868050100 Limbitrol amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

54868220601 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 12.5 mg-5 mg oral tablet oral long acting benzodiazepines d03462

00187380610 Limbitrol DS amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

00378027701 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

00378027705 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

00904170140 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

49884096201 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

54868042600 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

54868153400 Amitriptyline-ChlordiazePOXIDE amitriptyline-chlordiazePOXIDE 25 mg-10 mg oral tablet oral long acting benzodiazepines d03462

00115132901 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

00555078702 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

35356014730 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

35356014790 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

54092038301 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

54868476000 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

Page 42: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868476001 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

54868476002 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

54868476003 Adderall XR amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

54868603300 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 10 mg oral capsule, extended release

oral amphetamines d04035

00185011101 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

00406889201 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

00555076402 Adderall amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

00555097202 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

23490797403 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54092037301 Adderall amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868367400 Adderall amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868367401 Adderall amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868367402 Adderall amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472800 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472801 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472802 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472803 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472804 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

54868472805 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

55289068060 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

55289068090 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

63304090901 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

63629376801 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

Page 43: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

64720013210 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

67767010301 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 10 mg oral tablet oral amphetamines d04035

00406888601 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 12.5 mg oral tablet oral amphetamines d04035

00555076502 Adderall amphetamine-dextroamphetamine 12.5 mg oral tablet oral amphetamines d04035

00555077602 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 12.5 mg oral tablet oral amphetamines d04035

54092037401 Adderall amphetamine-dextroamphetamine 12.5 mg oral tablet oral amphetamines d04035

00115133001 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

00555079102 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

35356014830 Adderall XR amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

35356014890 Adderall XR amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

54092038501 Adderall XR amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

54868514000 Adderall XR amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

54868514001 Adderall XR amphetamine-dextroamphetamine 15 mg oral capsule, extended release

oral amphetamines d04035

00406888501 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 15 mg oral tablet oral amphetamines d04035

00555076602 Adderall amphetamine-dextroamphetamine 15 mg oral tablet oral amphetamines d04035

00555077702 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 15 mg oral tablet oral amphetamines d04035

54868538700 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 15 mg oral tablet oral amphetamines d04035

00115133101 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

00555078802 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

35356014930 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

Page 44: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

35356014990 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

54092038701 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

54868464000 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

54868464001 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

54868464002 Adderall XR amphetamine-dextroamphetamine 20 mg oral capsule, extended release

oral amphetamines d04035

00185040101 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

00406889301 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

00555076702 Adderall amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

00555097302 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

23490797506 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54092037601 Adderall amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868441000 Adderall amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868441001 Adderall amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868510300 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868510301 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868510302 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

54868510303 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

55289072260 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

55289072290 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

63304091001 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

63629376901 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

64720013510 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

Page 45: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

67767010601 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 20 mg oral tablet oral amphetamines d04035

00115133201 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

00555079202 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

54092038901 Adderall XR amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

54868536800 Adderall XR amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

54868536801 Adderall XR amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

54868602900 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 25 mg oral capsule, extended release

oral amphetamines d04035

00115133301 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

00555078902 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

35356015030 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

35356015090 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

54092039101 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

54868514200 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

54868514201 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

54868514202 Adderall XR amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

54868603400 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 30 mg oral capsule, extended release

oral amphetamines d04035

00185040401 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

Page 46: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00406889401 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

00555076802 Adderall amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

00555097402 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

54868486300 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

54868486301 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

54868547000 Adderall amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

54868547001 Adderall amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

63304091101 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

64720013610 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 30 mg oral tablet oral amphetamines d04035

00115132801 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

00555079002 Amphetamine-Dextroamphetamine ER amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

54092038101 Adderall XR amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

54868500700 Adderall XR amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

54868500701 Adderall XR amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

54868500702 Adderall XR amphetamine-dextroamphetamine 5 mg oral capsule, extended release

oral amphetamines d04035

00185008401 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

00406889101 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

00555076202 Adderall amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

00555097102 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

23490797303 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

54092037101 Adderall amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

54868397600 Adderall amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

Page 47: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868463100 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

54868463101 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

54868463102 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

54868463103 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

55289070030 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

55289070060 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

55289070090 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

63304090801 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

64720013010 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 5 mg oral tablet oral amphetamines d04035

00406888401 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 7.5 mg oral tablet oral amphetamines d04035

00555076302 Adderall amphetamine-dextroamphetamine 7.5 mg oral tablet oral amphetamines d04035

00555077502 Amphetamine-Dextroamphetamine amphetamine-dextroamphetamine 7.5 mg oral tablet oral amphetamines d04035

00185071301 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 385 mg-30 mg-25 mg oral tablet oral skeletal muscle relaxants d03472

00185071305 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 385 mg-30 mg-25 mg oral tablet oral skeletal muscle relaxants d03472

49884047201 Orphengesic aspirin/caffeine/orphenadrine 385 mg-30 mg-25 mg oral tablet oral skeletal muscle relaxants d03472

49884047205 Orphengesic aspirin/caffeine/orphenadrine 385 mg-30 mg-25 mg oral tablet oral skeletal muscle relaxants d03472

52959067360 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 385 mg-30 mg-25 mg oral tablet oral skeletal muscle relaxants d03472

00185071401 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247070808 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247070820 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

Page 48: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247070821 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247070828 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247070830 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247070836 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247154012 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247154020 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247154028 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00247154030 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00904523960 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

12280026730 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

21695072645 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

49884047301 Orphengesic Forte aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

49884047305 Orphengesic Forte aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

55045277706 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

62269026629 ASA/Caffeine/Orphenadrine aspirin/caffeine/orphenadrine 770 mg-60 mg-50 mg oral tablet oral skeletal muscle relaxants d03472

00002311102 Darvon Compound-65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

Page 49: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00002311103 Darvon Compound-65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00247097120 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00247097128 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00378013105 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00904770140 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00904770160 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00904770180 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

51641032301 PC-CAP aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

51641032305 PC-CAP aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

51641032310 PC-CAP aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

51641032311 PC-CAP aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

52959046220 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

54868146701 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

54868146702 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

57866436001 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

57866436002 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

Page 50: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

57866436003 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

57866436004 Aspirin/Caffeine/Propoxyphene Hydrochloride

aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021500 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021502 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021512 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021515 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021520 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021528 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021530 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021556 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

58016021560 Propoxyphene Compound 65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

66591061241 Darvon Compound-65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

68115074300 Darvon Compound-65 aspirin/caffeine/propoxyphene 389 mg-32.4 mg-65 mg oral capsule oral narcotics d03435

00037240301 Soma Compound with Codeine aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

00185074901 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

00247036924 Soma Compound with Codeine aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

Page 51: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247036930 Soma Compound with Codeine aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

00247176120 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

00603258421 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

52152013802 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

52959086800 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

52959086860 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

52959086890 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

55289047220 Soma Compound with Codeine aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019900 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019902 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019903 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019920 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019930 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019940 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019960 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019989 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

Page 52: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016019990 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

58016019999 ASA/Carisoprodol/Codeine Phosphate aspirin/carisoprodol/codeine 325 mg-200 mg-16 mg oral tablet oral skeletal muscle relaxants d03470

00037210301 Soma Compound aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00185072401 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00185072405 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028606 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028616 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028618 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028620 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028630 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00247028640 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00904035640 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

00904035660 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

23155014501 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

49884024601 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

49884024605 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

Page 53: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52152013702 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

52152013704 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

52959045402 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

52959045414 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

52959045460 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

54569256202 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

54569256203 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

55289069528 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

55289069540 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

58016299701 Aspirin-Carisoprodol aspirin-carisoprodol 325 mg-200 mg oral tablet oral skeletal muscle relaxants d03469

10551009110 Equagesic aspirin-meprobamate 325 mg-200 mg oral tablet oral antianxiety d03448

60267074230 Sal-Tropine atropine 0.4 mg oral tablet oral belladonna alkaloids d00174

63717081001 Atreza atropine 0.4 mg oral tablet oral belladonna alkaloids d00174

00247050903 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00247050904 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00247050908 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

Page 54: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247050910 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00247050920 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00247050930 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00603241921 Bellatal ER atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

49769025610 Servira atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

60258080401 Alkabel-SR atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

66213042110 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

66213042150 Donnatal Extentabs atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

68032025610 Servira atropine/hyoscyam/PHENobarb/scopolam 0.0582 mg-0.3111 mg-48.6 mg-0.0195 mg oral tablet, extended release

oral belladonna alkaloids d03485

00115465201 Spasmolin atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00115465203 Spasmolin atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00143114010 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

Page 55: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00143114051 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013800 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013803 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013804 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013806 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013808 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013810 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013812 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013815 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013816 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013820 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013824 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013828 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013830 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247013840 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00603241821 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

Page 56: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603241832 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

15338060060 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

49999007616 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

49999007620 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

49999007630 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

49999007690 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

52959002306 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

52959002320 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

52959002330 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

52959002350 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

52959002360 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54569042701 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54569042702 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54569042704 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54569042705 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54569042708 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

Page 57: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569042709 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54868003104 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54868123700 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54868123701 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

54868123702 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003501 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003514 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003520 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003528 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003530 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003560 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55289003597 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

55887006630 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070900 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070902 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070903 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

Page 58: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016070920 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070930 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070940 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070942 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070950 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070973 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58016070989 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

58521016205 Bellatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

60760075430 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030901 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030902 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030904 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030915 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030920 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030930 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030940 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

Page 59: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874030942 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030950 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030960 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030972 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030974 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

63874030977 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

64125012810 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

66213042510 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

66213042511 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

66336004215 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

66336004220 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

66336004230 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

68115004120 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

68115004130 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg oral tablet

oral belladonna alkaloids d03485

00247050704 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00247050705 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

Page 60: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247050710 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00247050730 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00247050752 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00247050760 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00247050777 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00254903558 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00551019501 D-Tal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00603103058 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00904098100 Donnapine atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00904098116 Donnapine atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00904098120 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

00904098128 Donnapine atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

13925015816 Se-Donna PB Hyos atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

17856042330 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

17856042331 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

42192052016 Quadrapax atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

Page 61: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49769039516 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

49999074604 Antispasmodic atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

52959027403 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

52959027406 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

52959027430 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

54569042600 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

55289058604 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

55289058608 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

55887078304 Antispasmodic atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

60258082216 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

60258082228 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

60432000904 Antispasmodic atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

60432000916 Antispasmodic atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

63874072412 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

66213042204 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

66213042216 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

Page 62: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66213042304 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

66213042316 Donnatal atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

68115089704 Belladonna-PHENobarbital atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral elixir

oral belladonna alkaloids d03485

68032039516 PB-Hyos atropine/hyoscyamine/PHENobarbital/scopolamine 0.0194 mg-0.1037 mg-16.2 mg-0.0065 mg/5 mL oral liquid

oral belladonna alkaloids d03485

00187050001 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

00187050002 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

54868351000 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

54868351001 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

65234007405 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

65234007410 Motofen atropine-difenoxin 0.025 mg-1 mg oral tablet oral belladonna alkaloids d03505

00025006131 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00025006151 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00025006152 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00025006155 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00185002401 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00185002405 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00185002410 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009500 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009503 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009504 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009506 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009508 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009510 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

Page 63: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247009512 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009515 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009516 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009518 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009520 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009530 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009540 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00247009550 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00339403712 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00378041501 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00378041510 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00378041577 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00406046301 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00406046310 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00527117001 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00527117010 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00615042901 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00615042910 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00781126201 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00781126205 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00781126210 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00781126213 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00904003260 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00904003280 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

12280021200 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

Page 64: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

12280029660 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

21695068815 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

23490546101 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

23490546102 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

23490546103 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

23490546104 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

23490546105 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

43063008904 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

43063008906 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49884077101 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49884077110 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49999020700 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49999020710 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49999020720 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

49999020730 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

51079006701 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

51079006719 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

51079006720 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015700 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015710 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015712 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015715 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015720 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015730 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

52959015750 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

Page 65: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569022200 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868003200 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868042700 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868042701 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868042702 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868042703 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

54868042704 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55289010210 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55289010215 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55289010220 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55289010230 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55289023010 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084101 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084108 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084111 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084115 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084120 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084125 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

55887084130 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

57866376301 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071300 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071306 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071310 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071312 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071314 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

Page 66: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016071315 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071316 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071320 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071321 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071324 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071328 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071330 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071340 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58016071360 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

58864016630 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

59762106101 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026101 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026110 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026112 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026114 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026115 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026120 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026121 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026124 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026128 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026130 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026140 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

63874026160 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

65162030110 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

65162030111 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

Page 67: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

67544002130 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

67544041130 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

67544057730 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

68115011815 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

68115011820 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

68115011830 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

68387054412 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg oral tablet oral belladonna alkaloids d03506

00025006602 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

00054319446 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

00247140160 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

52959094960 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

54868151101 Lomotil atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

63874027712 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

63874027760 Atropine SO4-Diphenoxylate HCl atropine-diphenoxylate 0.025 mg-2.5 mg/5 mL oral liquid oral belladonna alkaloids d03506

17317004201 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

17317004204 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

17317004401 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

17317004404 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

49452013602 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

49452090001 Belladonna Tincture belladonna oral liquid oral belladonna alkaloids d00988

00603242321 Bellaspas belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

00603242328 Bellaspas belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

51285090705 Duragal-S belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

Page 68: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51991004501 Spastrin belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

52152011502 Bellamine S belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

52152011505 Bellamine S belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

64125010201 Eperbel-S belladonna/ergotamine/PHENobarbital 0.2 mg-0.6 mg-40 mg oral tablet, extended release

oral belladonna alkaloids d03495

00574704512 Belladonna Alkaloids-Opium belladonna-opium 16.2 mg-30 mg rectal suppository rectal narcotics d03436

61451501507 B & O Supprettes 15-A belladonna-opium 16.2 mg-30 mg rectal suppository rectal narcotics d03436

00574704012 Belladonna Alkaloids-Opium belladonna-opium 16.2 mg-60 mg rectal suppository rectal narcotics d03436

61451501607 B & O Supprettes 16-A belladonna-opium 16.2 mg-60 mg rectal suppository rectal narcotics d03436

00009002401 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

00009002402 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

00115120501 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

00247171730 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

00574011601 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

00574011605 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

00574011630 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

10702004001 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

10702004003 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

10702004050 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

23490513301 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

23490513302 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

23490513303 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

54569038900 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

54569038901 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

Page 69: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569038905 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

54569038906 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

54569294903 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

54569294904 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

54569607800 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015814 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015828 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015830 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015856 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015860 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289015890 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

55289043228 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

55289043256 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

55289043260 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

55289043290 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

64376065001 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64376065005 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64376065031 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64376065090 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64720019401 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64720019410 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64720019450 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

64980014501 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

66336067821 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

66336099230 Benzphetamine Hydrochloride benzphetamine 50 mg oral tablet oral amphetamines d00807

Page 70: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115010821 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

68115010830 Didrex benzphetamine 50 mg oral tablet oral amphetamines d00807

00037011360 Butisol Sodium butabarbital 30 mg oral tablet oral barbiturates d00923

00037011380 Butisol Sodium butabarbital 30 mg oral tablet oral barbiturates d00923

00037011016 Butisol Sodium butabarbital 30 mg/5 mL oral elixir oral barbiturates d00923

00037011460 Butisol Sodium butabarbital 50 mg oral tablet oral barbiturates d00923

00430018215 Pyridium Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

10267292903 Phenazopyridine Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

10267292905 Phenazopyridine Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

15310007003 Phenazopyridine Fort Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

51991025133 Phenazopyridine Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

54569019201 Pyridium Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

54569019202 Pyridium Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

60258051303 Urelief Plus butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

66663070201 Pyrelle H.B. butabarbital/hyoscyamine/phenazopyridine 15 mg-0.3 mg-150 mg oral tablet

oral belladonna alkaloids d04393

10914093106 Carbetapentane/DiphenhydrAMINE/Phenylephrine

carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-10 mg oral tablet, chewable, extended release

oral antihistamines d04895

63717058106 Dytan-CS carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-10 mg oral tablet, extended release

oral antihistamines d04895

68308075560 D-Tann CT carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-10 mg oral tablet, extended release

oral antihistamines d04895

Page 71: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63717058504 Dytan-CD carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-15 mg/5 mL oral suspension, extended release

oral antihistamines d04895

68308014004 D-Tann CD carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-15 mg/5 mL oral suspension, extended release

oral antihistamines d04895

63717058004 Dytan-CS carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04895

68308013004 D-Tann CT carbetapentane/diphenhydrAMINE/phenylephrine 30 mg-25 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04895

00037225010 Soma carisoprodol 250 mg oral tablet oral skeletal muscle relaxants d00960

00037225030 Soma carisoprodol 250 mg oral tablet oral skeletal muscle relaxants d00960

18837029440 Soma carisoprodol 250 mg oral tablet oral skeletal muscle relaxants d00960

35356050130 Soma carisoprodol 250 mg oral tablet oral skeletal muscle relaxants d00960

51525590101 Carisoprodol carisoprodol 250 mg oral tablet oral skeletal muscle relaxants d00960

00037200101 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00037200103 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00143117601 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00143117605 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00143117610 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00143974901 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00143974905 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 72: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00143974910 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008800 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008802 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008803 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008804 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008806 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008807 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008810 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008814 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008815 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008816 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008818 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008820 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008821 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008828 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008830 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 73: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247008840 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008852 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008856 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008860 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008877 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247008890 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247105421 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00247105460 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00254241038 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00591551301 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00591551305 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00591551310 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00603258221 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00603258228 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00603258232 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00615151901 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 74: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00615151905 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00781500501 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00781500505 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00904035560 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

10544030328 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

12280004400 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

16590003930 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

16590003945 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

16590003960 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

16590003972 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

16590003990 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

21695002115 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

21695002130 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

21695002160 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

21695002172 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

21695002190 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 75: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490521200 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521201 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521202 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521203 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521205 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521206 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521207 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521208 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490521209 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490791700 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490791704 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490791705 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490791707 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

23490791708 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

33358006401 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006400 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 76: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999006401 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006406 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006407 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006410 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006414 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006415 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006418 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006420 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006430 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006440 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006450 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006460 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

49999006490 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

51079005501 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

51079005520 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

51079081901 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 77: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079081920 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

51285087404 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

51285087405 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52152013602 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52152013604 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52152013605 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002600 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002603 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002606 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002610 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002612 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002614 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002615 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002620 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002621 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002624 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 78: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959002625 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002628 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002630 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002632 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002640 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002645 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002650 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002652 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002656 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002660 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002680 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

52959002690 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

53489011001 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

53489011005 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

53489011010 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569083405 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 79: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569170900 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170901 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170902 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170903 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170904 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170905 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170907 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569170908 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340300 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340301 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340304 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340305 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340306 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54569340307 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868002000 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868002001 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 80: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868002002 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081601 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081602 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081603 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081604 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081605 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081606 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

54868081607 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143300 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143301 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143302 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143303 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143304 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143305 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143306 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143307 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 81: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045143308 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045143309 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045312306 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55045312309 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004901 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004910 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004914 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004915 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004920 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004921 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004924 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004930 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004940 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004960 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004990 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289004998 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 82: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289057820 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55289057840 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099010 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099014 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099020 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099025 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099028 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099030 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099040 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099060 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099082 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

55887099090 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016003800 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016003830 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016003860 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016003890 Soma carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 83: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016026171 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048800 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048802 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048803 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048804 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048807 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048810 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048812 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048814 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048815 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048816 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048818 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048820 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048821 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048824 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048825 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 84: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016048828 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048830 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048840 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048842 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048845 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048850 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048856 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048860 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048862 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048873 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048880 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048889 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048890 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048892 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58016048899 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

58809042401 Vanadom carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 85: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60760011030 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

60760011040 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

60760011060 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

60760011090 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

61392071145 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

61392071154 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

61392071191 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

62756044602 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

62756044604 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

62756044605 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63629130800 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63739004910 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63739004915 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033001 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033002 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033003 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 86: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874033004 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033005 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033007 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033010 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033011 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033012 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033014 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033015 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033016 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033018 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033020 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033021 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033024 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033025 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033028 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033030 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 87: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874033040 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033042 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033045 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033050 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033056 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033060 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033072 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033074 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033075 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033077 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033080 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033084 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

63874033090 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

64720010310 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

64720010311 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

64720010350 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 88: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

65862015801 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004312 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004315 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004320 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004330 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004340 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004345 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004360 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004390 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267004391 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66267100700 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66336063515 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66336063520 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66336063530 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66336063560 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

66336063590 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 89: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336063594 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

67544029130 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

67544047330 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68013001601 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68084038001 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68084038011 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006300 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006304 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006312 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006315 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006320 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006328 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006330 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006340 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006345 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006348 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 90: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115006350 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006356 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006360 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006390 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006396 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006397 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115006399 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044000 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044004 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044012 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044015 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044020 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044021 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044028 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044030 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044040 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

Page 91: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115044045 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044048 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044050 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044056 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044060 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044090 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044097 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

68115044099 Carisoprodol carisoprodol 350 mg oral tablet oral skeletal muscle relaxants d00960

00187375110 Librium chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00247195804 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00440725130 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00555003302 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00555003305 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00591078610 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00615043601 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00615043610 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

Page 92: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904009140 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00904009160 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00904009180 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

23490526601 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

43547025210 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

49884095901 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

51079037501 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

51079037520 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

54868007000 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

55289006106 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

55887085630 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082100 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082108 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082110 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082112 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082114 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

Page 93: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016082115 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082120 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082121 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082124 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082125 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082128 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082130 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082140 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082150 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016082160 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016099600 Librium chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016099630 Librium chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016099660 Librium chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

58016099690 Librium chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

60429055501 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025601 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

Page 94: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874025608 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025610 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025612 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025614 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025615 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025620 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025621 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025624 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025625 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025628 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025630 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025640 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

63874025660 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

66336074230 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

67544001330 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

67544058030 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

Page 95: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68071073460 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 10 mg oral capsule oral long acting benzodiazepines d00189

00187375810 Librium chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00247142404 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00247142412 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00440725212 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00555015902 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00555015904 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00591078701 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00615043701 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00615043705 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00615043710 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00904009240 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00904009260 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

23490526701 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

23490526702 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

23490526703 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

Page 96: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

43063004603 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

43063004606 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

43063004615 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

43063004619 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

43547025310 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

49884096001 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

49999024410 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

49999024420 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

49999024430 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

51079014101 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

51079014120 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

55045178108 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

55887084830 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

58016006400 Librium chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

58016006430 Librium chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

58016006460 Librium chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

Page 97: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016006490 Librium chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

60429055601 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

63874027410 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

63874027412 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

63874027430 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

67544011530 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

67544027430 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

68115007430 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 25 mg oral capsule oral long acting benzodiazepines d00189

00187375010 Librium chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00555015802 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00555015804 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00591078501 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00591078505 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00904009040 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00904009060 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00904009080 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

Page 98: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

43547025110 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

49884095801 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

49999021450 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

51079037401 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

51079037420 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

54868246300 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

58016082200 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

58016082212 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

58016082215 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

58016082220 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

58016082230 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

60429055401 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral capsule oral long acting benzodiazepines d00189

00615043505 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral tablet oral long acting benzodiazepines d00189

00615043510 ChlordiazePOXIDE Hydrochloride chlordiazePOXIDE 5 mg oral tablet oral long acting benzodiazepines d00189

00187410010 Librax chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00247018615 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

Page 99: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247018616 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00247018620 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00247018624 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00247018630 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00603271421 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00603271432 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

23490526901 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

23490526902 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

23490526903 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

42192033601 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

49999007930 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

51991062201 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

52152001802 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

52152001804 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

52152001805 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54569043000 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

Page 100: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569043001 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54569043002 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54569043003 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54868003000 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54868003002 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54868003003 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54868003004 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

54868003005 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55289006217 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55289006230 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55289006260 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55887068401 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55887068430 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

55887068460 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

58016098460 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

58016098490 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

Page 101: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60429018901 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

63874035601 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

63874035615 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

63874035620 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

63874035630 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

64125013201 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

64125013210 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

64376080801 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

66336078028 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

66336078056 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

67877018601 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

68032036910 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

68115074400 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

68682040910 ChlordiazePOXIDE-Clidinium chlordiazePOXIDE-clidinium 5 mg-2.5 mg oral capsule oral long acting benzodiazepines d03492

00069393066 Diabinese chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

00182185101 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

00182185189 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

00378019701 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

Page 102: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378019705 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

00904022561 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

50111037201 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

51079020201 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

51079020220 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

54569201701 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

54868087701 ChlorproPAMIDE chlorproPAMIDE 100 mg oral tablet oral oral hypoglycemics d00042

00069394066 Diabinese chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00247104530 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00247104545 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00378021001 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00378021010 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00904022661 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00904022680 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

50111037301 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

50111037303 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

51079020301 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

51079020320 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54569020300 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54569020301 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54569020340 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54868003600 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54868003602 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

54868003604 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

55289006690 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

Page 103: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289006697 ChlorproPAMIDE chlorproPAMIDE 250 mg oral tablet oral oral hypoglycemics d00042

00182178001 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

00247034120 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

00247034130 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

00904029460 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

52152005302 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

52152005305 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

55289037620 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

55289037640 Chlorzoxazone chlorzoxazone 250 mg oral tablet oral skeletal muscle relaxants d00962

68025004610 Lorzone chlorzoxazone 375 mg oral tablet oral skeletal muscle relaxants d00962

00045032560 Parafon Forte DSC chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00093054201 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00093054205 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00182118905 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011203 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011204 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011210 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 104: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247011212 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011214 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011215 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011216 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011220 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011224 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011228 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011230 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00247011240 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00555058502 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00555058504 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00591252001 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00591396801 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00591396805 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00677167001 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

00904030040 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 105: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904030060 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

21695056930 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

23490531001 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

23490531002 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

23490531003 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

23490531004 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004410 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004414 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004415 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004418 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004420 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004430 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004440 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004460 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

49999004490 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

50458062560 Parafon Forte DSC chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 106: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079047601 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

51079047620 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52152002502 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52152002504 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003500 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003501 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003510 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003520 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003521 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003528 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003530 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003540 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003556 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003560 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003570 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

52959003590 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 107: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569150603 Parafon Forte DSC chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197000 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197001 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197002 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197004 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197005 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197006 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54569197009 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073500 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073501 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073502 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073503 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073504 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073505 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073507 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868073508 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 108: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868073509 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

54868101700 Parafon Forte DSC chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55045159400 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063308 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063310 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063317 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063320 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063324 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063328 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063330 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063340 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289063397 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55289088824 Parafon Forte DSC chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55887079928 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55887079930 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

55887079960 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 109: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

57664012213 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

57866344401 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

57866344404 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

57866344406 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029100 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029102 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029103 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029108 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029110 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029112 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029114 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029115 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029116 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029120 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029121 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029124 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 110: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016029128 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029130 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029140 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029142 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029156 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029160 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029173 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029189 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

58016029190 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63629158601 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041901 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041903 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041904 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041908 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041910 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041912 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 111: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874041914 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041915 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041916 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041920 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041921 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041924 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041928 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041930 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041940 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041942 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041950 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041956 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041960 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041972 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041974 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

63874041977 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

Page 112: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874041990 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66267005520 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66267005530 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66267005540 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66267005560 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66336066315 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

66336066330 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007700 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007715 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007730 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007740 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007760 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68115007790 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68387037530 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68387037590 Chlorzoxazone chlorzoxazone 500 mg oral tablet oral skeletal muscle relaxants d00962

68025004710 Lorzone chlorzoxazone 750 mg oral tablet oral skeletal muscle relaxants d00962

Page 113: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00472162904 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

00472162916 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

00603158854 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

00603158858 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

49999032604 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

52959022904 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

54569304402 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

54868026300 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

54868026301 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

55045126608 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

63629295901 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

63874020912 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

63874020918 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

63874020924 Promethazine VC with Codeine codeine/phenylephrine/promethazine 10 mg-5 mg-6.25 mg/5 mL oral syrup

oral antihistamines d03364

00121054705 Promethazine HCl and Codeine Phosphatecodeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008104 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008110 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

Page 114: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247008120 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008130 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008138 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008152 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008159 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008160 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008177 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00247008189 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00472162704 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00472162716 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00603158554 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00603158558 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

16590019204 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

21695033604 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

23490618801 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

49999015204 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

50383080416 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

52959011803 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

52959011805 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

Page 115: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959011806 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

52959011808 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

54569105600 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

54569354002 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

54868102900 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

54868102901 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

54868102902 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

55045168702 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

55887076604 Promethazine HCl and Codeine Phosphatecodeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

57664018531 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

57664018534 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

58016039001 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

60432060616 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63629160701 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63629160702 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63629160703 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63874020412 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

Page 116: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874020418 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63874020424 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63874020438 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

63874020448 Codeine Phosphate-Promethazine HCl codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

68115091504 Promethazine with Codeine codeine-promethazine 10 mg-6.25 mg/5 mL oral syrup oral antihistamines d03357

00046110081 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

00046110091 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

00247122630 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

35356024900 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54569081101 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54569851700 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54569851701 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54868270200 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54868270201 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54868270202 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54868270203 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

54868270204 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

55289012330 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074400 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074410 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074412 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074414 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074415 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

Page 117: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016074420 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

58016074430 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015801 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015810 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015814 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015815 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015820 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

63874015830 Premarin conjugated estrogens 0.3 mg oral tablet oral estrogens d00541

00046110181 Premarin conjugated estrogens 0.45 mg oral tablet oral estrogens d00541

35356025100 Premarin conjugated estrogens 0.45 mg oral tablet oral estrogens d00541

54868486500 Premarin conjugated estrogens 0.45 mg oral tablet oral estrogens d00541

54868486501 Premarin conjugated estrogens 0.45 mg oral tablet oral estrogens d00541

00046110281 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00046110291 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00247025100 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00247025101 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00247025130 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00247025160 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00247025190 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

12280003900 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

49999010900 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

49999010930 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

49999010990 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

51655045224 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

51655045225 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

Page 118: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959022300 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

52959022330 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569081200 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569081201 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569081202 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569081205 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569800600 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569800601 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569800602 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569850000 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569850001 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54569850002 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045100 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045101 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045102 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045103 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045106 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

54868045107 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

55289094307 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

55289094325 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

55289094328 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

55289094330 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

55887070230 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094800 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094810 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

Page 119: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016094812 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094814 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094815 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094820 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094830 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58016094850 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58864042228 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

58864042230 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

66105013710 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

66267017430 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

66336059930 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

67801032603 Premarin conjugated estrogens 0.625 mg oral tablet oral estrogens d00541

00046110381 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00247024900 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00247024915 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00247024930 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00247024960 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00247024990 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

33358029530 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

35356025000 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54569084900 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54569084901 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54569851800 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54569851801 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54868036500 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

Page 120: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868036502 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

54868036503 Premarin conjugated estrogens 0.9 mg oral tablet oral estrogens d00541

00046110481 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

00046110491 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

00247025000 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

00247025028 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

00247025030 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

00440817190 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

35356042630 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

52959022200 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569081300 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569081301 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569801400 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569850500 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569850501 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54569850502 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045300 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045301 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045302 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045304 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045305 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

54868045306 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

55289004725 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

55289004730 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

55289004742 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

Page 121: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289004790 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

66105013810 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

67801032703 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

68115029430 Premarin conjugated estrogens 1.25 mg oral tablet oral estrogens d00541

51285044102 Cenestin conjugated estrogens synthetic A, 0.3 mg oral tablet oral estrogens d00541

51285044602 Cenestin conjugated estrogens synthetic A, 0.45 mg oral tablet oral estrogens d00541

54868541500 Cenestin conjugated estrogens synthetic A, 0.45 mg oral tablet oral estrogens d00541

54868541501 Cenestin conjugated estrogens synthetic A, 0.45 mg oral tablet oral estrogens d00541

51285044202 Cenestin conjugated estrogens synthetic A, 0.625 mg oral tablet oral estrogens d00541

51285044205 Cenestin conjugated estrogens synthetic A, 0.625 mg oral tablet oral estrogens d00541

54868487900 Cenestin conjugated estrogens synthetic A, 0.625 mg oral tablet oral estrogens d00541

54868487901 Cenestin conjugated estrogens synthetic A, 0.625 mg oral tablet oral estrogens d00541

54868487902 Cenestin conjugated estrogens synthetic A, 0.625 mg oral tablet oral estrogens d00541

51285044302 Cenestin conjugated estrogens synthetic A, 0.9 mg oral tablet oral estrogens d00541

51285044402 Cenestin conjugated estrogens synthetic A, 1.25 mg oral tablet oral estrogens d00541

54868143200 Cenestin conjugated estrogens synthetic A, 1.25 mg oral tablet oral estrogens d00541

54868143201 Cenestin conjugated estrogens synthetic A, 1.25 mg oral tablet oral estrogens d00541

51285040602 Enjuvia conjugated estrogens synthetic B, 0.3 mg oral tablet oral estrogens d00541

51285040702 Enjuvia conjugated estrogens synthetic B, 0.45 mg oral tablet oral estrogens d00541

51285040802 Enjuvia conjugated estrogens synthetic B, 0.625 mg oral tablet oral estrogens d00541

51285040902 Enjuvia conjugated estrogens synthetic B, 0.9 mg oral tablet oral estrogens d00541

51285041002 Enjuvia conjugated estrogens synthetic B, 1.25 mg oral tablet oral estrogens d00541

00046093808 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

00046093809 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

Page 122: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00046093818 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

00046110511 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

35356027628 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

54868504700 Prempro conjugated estrogens-medroxyPROGESTERone 0.3 mg-1.5 mg oral tablet

oral estrogens d03819

00046093708 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

00046093709 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

00046093718 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

00046110611 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

35356027928 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

54868486600 Prempro conjugated estrogens-medroxyPROGESTERone 0.45 mg-1.5 mg oral tablet

oral estrogens d03819

00046087505 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00046087506 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00046087511 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00046110711 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00247170201 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00247170228 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

Page 123: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

35356027728 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

54569461800 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

54868379900 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

58016407401 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-2.5 mg oral tablet

oral estrogens d03819

00046097505 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

00046097506 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

00046097511 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

35356027828 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

54569492500 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

54868554000 Prempro conjugated estrogens-medroxyPROGESTERone 0.625 mg-5 mg oral tablet

oral estrogens d03819

00046257301 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

00046257305 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

00046257306 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

00046257911 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

00247170328 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

54569467300 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

Page 124: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868380000 Premphase conjugated estrogens-medroxyPROGESTERone biphasic oral tablet oral estrogens d03819

00093191919 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00093191993 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00182191900 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00182191989 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005900 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005901 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005902 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005903 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005904 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005905 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005906 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005907 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005908 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005909 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005910 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 125: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247005912 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005914 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005915 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005918 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005920 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005921 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005928 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005930 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005940 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005942 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005960 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005990 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005998 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247005999 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247039107 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247039115 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 126: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247039120 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247039130 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00247039140 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00378075101 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00378075105 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00378075110 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00378075193 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00440735009 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00591565801 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00591565805 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00591565810 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00603307921 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00603307928 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00603307932 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00603307934 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00615352063 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 127: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00781132410 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904222140 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904222160 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904222161 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904222180 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904758640 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904758660 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904758661 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904758680 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904780960 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00904780961 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

10544030830 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

10544030860 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

12280026690 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006512 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006515 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 128: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590006520 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006521 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006530 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006540 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006560 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

16590006590 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

18837003315 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

18837003330 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

18837003360 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

18837003390 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

18837003394 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003710 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003714 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003715 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003720 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003730 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 129: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

21695003745 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003760 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

21695003790 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490038102 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490038103 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490038106 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537700 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537701 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537702 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537703 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537704 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537705 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537706 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537707 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537708 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490537709 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 130: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490794001 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

23490794002 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009700 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009701 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009715 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009720 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009728 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009730 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009760 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

33358009790 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

35356026515 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

35356026520 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

43063005003 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

43063005004 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

43063005006 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003401 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 131: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999003407 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003412 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003415 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003420 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003421 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003430 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003460 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

49999003490 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

50111056301 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

50111056302 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

50111056303 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

50580087411 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51079064401 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51079064419 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51079064420 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51079064493 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 132: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079064497 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51285087302 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51285087304 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51285087305 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044024 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044025 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044052 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044054 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044085 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51655044089 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51991046801 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

51991046810 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52152030202 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52152030205 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004200 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004202 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 133: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959004204 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004207 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004210 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004212 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004214 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004215 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004220 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004221 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004225 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004228 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004230 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004235 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004240 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004245 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004260 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959004290 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 134: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959006910 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959006915 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959006920 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959006921 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959006930 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

52959006940 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

53489059101 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

53489059105 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

53489059110 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569083500 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569083502 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569083508 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257300 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257301 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257302 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257303 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 135: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569257304 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257306 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257307 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257308 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569257309 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319300 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319301 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319305 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319307 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319308 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569319309 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569400800 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569400801 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54569518400 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868031800 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868031801 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 136: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868031802 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868031803 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868031804 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111000 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111002 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111003 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111005 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111008 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

54868111009 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156600 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156601 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156602 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156603 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156604 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156605 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156606 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 137: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045156607 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156608 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045156609 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045305801 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045305804 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045305805 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045305806 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045305809 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55045371701 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289011515 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289011520 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289011521 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289011530 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056710 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056712 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056714 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 138: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289056715 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056717 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056718 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056720 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056721 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056730 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056742 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056760 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55289056790 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098910 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098912 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098915 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098916 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098920 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098921 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098930 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 139: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887098940 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098950 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098960 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098982 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098990 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

55887098992 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484201 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484202 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484204 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484206 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484207 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

57866484208 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016007000 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016007030 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016007060 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016007090 Flexeril cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 140: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016023400 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023402 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023407 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023410 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023412 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023414 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023415 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023418 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023420 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023421 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023424 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023428 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023430 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023440 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023445 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023450 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 141: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016023456 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023460 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023490 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58016023499 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58864012820 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58864012830 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

58864012845 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

59746017706 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

59746017710 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

60760041809 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

60760041820 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

60760041830 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

60760041860 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

61392071645 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

61392071654 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

61392071691 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 142: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

62584035401 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

62584035411 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133901 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133902 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133903 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133904 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133905 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133906 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63629133907 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63739006610 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63739006615 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031501 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031502 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031504 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031505 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031507 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 143: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874031510 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031512 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031514 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031515 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031518 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031520 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031521 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031524 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031525 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031528 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031530 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031535 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031540 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031542 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031545 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031550 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 144: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874031556 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031560 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031575 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031576 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031580 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

63874031590 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

64038004201 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

64038004230 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

64038004260 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

64038004290 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65162054110 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65162054111 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65162054150 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65862019101 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65862019105 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

65862019199 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 145: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267006410 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006415 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006420 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006430 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006440 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006445 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006460 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006490 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66267006491 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058109 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058112 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058115 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058120 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058121 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058130 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

66336058160 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 146: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

67544018030 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

67544050830 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68084039701 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68084039711 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009500 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009506 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009510 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009512 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009515 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009520 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009530 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009540 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009545 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009548 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009560 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68115009590 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

Page 147: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115009599 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050010 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050015 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050030 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050045 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050060 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68387050090 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68462055301 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

68462055310 Cyclobenzaprine Hydrochloride cyclobenzaprine 10 mg oral tablet oral skeletal muscle relaxants d00963

00095015006 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

00378881591 Cyclobenzaprine Hydrochloride ER cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

18837033611 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

18837033630 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

21695072314 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

21695072328 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

35356026210 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

Page 148: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

35356026230 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

35356026260 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

35356026290 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

54868602200 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

55253027660 Cyclobenzaprine Hydrochloride ER cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

63459070060 Amrix cyclobenzaprine 15 mg oral capsule, extended release oral skeletal muscle relaxants d00963

00095030006 Amrix cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

00378881691 Cyclobenzaprine Hydrochloride ER cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

35356026301 Amrix cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

35356026330 Amrix cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

55253027760 Cyclobenzaprine Hydrochloride ER cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

63459070160 Amrix cyclobenzaprine 30 mg oral capsule, extended release oral skeletal muscle relaxants d00963

00247221921 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00378077101 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00378077105 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00378077193 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

Page 149: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00591325601 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00603307821 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00603307828 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00781503201 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

00781503210 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

10135050601 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

10147079001 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

16590009530 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

16590009560 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

21695003620 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

21695003630 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

23490767300 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

23490767301 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

23490767303 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

23490767304 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

49999027410 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

Page 150: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999027421 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

49999079100 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

49999079121 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

49999079130 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

50111082001 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

50580028010 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

51991046701 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

51991046710 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52152030102 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959000610 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959000620 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959000630 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959000690 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084600 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084610 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084615 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

Page 151: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959084620 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084630 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084642 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084660 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

52959084690 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

53489059001 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

54569553800 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

54569578200 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

54868537500 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

54868537501 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

54868559700 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55045348701 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55289023610 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55289023614 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55289023630 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55289074510 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

Page 152: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289074520 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887043530 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887082210 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887082214 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887082230 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887082260 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

55887082290 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016007600 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016007630 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016007660 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016007690 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016007699 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016098700 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016098702 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016098703 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016098730 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

Page 153: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016098760 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

58016098790 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

59746021106 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

59746021110 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

63874118603 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

63874118604 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

63874118606 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

63874118609 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68071046214 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68071046230 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68071046260 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68071046290 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68115045030 Flexeril cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68387050290 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68462055201 Cyclobenzaprine Hydrochloride cyclobenzaprine 5 mg oral tablet oral skeletal muscle relaxants d00963

68453095010 Fexmid cyclobenzaprine 7.5 mg oral tablet oral skeletal muscle relaxants d00963

00182135540 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

Page 154: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00472075516 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

00472140016 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

00904114616 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

00904114628 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

54569298400 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

54569298401 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

54868433800 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

64980050448 Cyproheptadine Hydrochloride cyproheptadine 2 mg/5 mL oral syrup oral antihistamines d00790

00006006268 Periactin cyproheptadine 4 mg oral tablet oral antihistamines d00790

00093292901 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00093292910 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00093292993 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00147023605 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00172292960 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00172292980 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00182113200 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00182113289 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00615153613 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00904114561 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00904114570 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

42291022510 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

49884004301 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

49884004310 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

49999049318 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

50111031401 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

Page 155: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50111031403 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

51655027652 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54569041101 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133201 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133202 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133203 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133204 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133205 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133206 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

54868133207 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

55289008920 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

55289008930 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

58016004100 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

58016004130 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

58016004160 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

58016004190 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

60258085001 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

60258085010 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

61392020956 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

61392020991 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

63629298201 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

63629298202 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

64980012301 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

64980012310 Cyproheptadine Hydrochloride cyproheptadine 4 mg oral tablet oral antihistamines d00790

00085082003 Polaramine dexchlorpheniramine 2 mg oral tablet oral antihistamines d00784

Page 156: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60432053916 Dexchlorpheniramine Maleate dexchlorpheniramine 2 mg/5 mL oral syrup oral antihistamines d00784

00603319821 Dexchlorpheniramine Maleate ER dexchlorpheniramine 4 mg oral tablet, extended release oral antihistamines d00784

52152001402 Dexchlorpheniramine Maleate ER dexchlorpheniramine 4 mg oral tablet, extended release oral antihistamines d00784

00182101501 Dexchlorpheniramine Maleate ER dexchlorpheniramine 6 mg oral tablet, extended release oral antihistamines d00784

52152001502 Dexchlorpheniramine Maleate ER dexchlorpheniramine 6 mg oral tablet, extended release oral antihistamines d00784

50383088016 Tannate PD-DM dexchlorpheniramine/dextromethorphan/PSE 3 mg-27.5 mg-50 mg/5 mL oral suspension, extended release

oral antihistamines d04818

60258040116 SuTan-DM dexchlorpheniramine/dextromethorphan/PSE 3 mg-27.5 mg-50 mg/5 mL oral suspension, extended release

oral antihistamines d04818

66869010710 TanDur DM dexchlorpheniramine/dextromethorphan/PSE 3 mg-27.5 mg-50 mg/5 mL oral suspension, extended release

oral antihistamines d04818

60258041016 Bromatan Plus dexchlorpheniramine/dextromethorphan/PSE 3.5 mg-30 mg-45 mg/5 mL oral suspension, extended release

oral antihistamines d04818

66869015410 DuraTan Forte dexchlorpheniramine/dextromethorphan/PSE 3.5 mg-30 mg-45 mg/5 mL oral suspension, extended release

oral antihistamines d04818

68308073716 Dur-Tann Forte dexchlorpheniramine/dextromethorphan/PSE 3.5 mg-30 mg-45 mg/5 mL oral suspension, extended release

oral antihistamines d04818

50383086604 Tannate DMP-DEX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

50383086616 Tannate DMP-DEX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

59630047004 Tanafed DMX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

59630047016 Tanafed DMX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

60432019804 C-Phed DPD Tann dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

60432019816 C-Phed DPD Tann dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

61787086604 Tanafed-DMX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

Page 157: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61787086616 Tanafed-DMX dexchlorpheniramine/DM/PSE 2.5 mg-25 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04818

00085026805 Polaramine Expectorant dexchlorpheniramine/guaiFENesin/pseudoephedrine 2 mg-100 mg-20 mg/5 mL oral syrup

oral antihistamines d03914

68453014504 Codimal DH dexchlorpheniramine/HYDROcodone/phenylephrine 1 mg-2 mg-5 mg/5 mL oral syrup

oral antihistamines d05365

68453014516 Codimal DH dexchlorpheniramine/HYDROcodone/phenylephrine 1 mg-2 mg-5 mg/5 mL oral syrup

oral antihistamines d05365

45985065216 Notuss PD dexchlorpheniramine/HYDROcodone/phenylephrine 2 mg-4 mg-5 mg/5 mL oral liquid

oral antihistamines d05365

60258068316 Hydex PD dexchlorpheniramine/HYDROcodone/phenylephrine 2 mg-4 mg-5 mg/5 mL oral liquid

oral antihistamines d05365

68025003216 Zotex HC dexchlorpheniramine/HYDROcodone/phenylephrine 2 mg-4 mg-5 mg/5 mL oral liquid

oral antihistamines d05365

68047013616 EndaCof-Plus dexchlorpheniramine/HYDROcodone/phenylephrine 2 mg-4 mg-5 mg/5 mL oral liquid

oral antihistamines d05365

51991058301 Histatab D dexchlorpheniramine/methscopolamine/pseudoephedrine 3.5 mg-1 mg-45 mg oral tablet, extended release

oral antihistamines d05539

66869042610 Durahist D dexchlorpheniramine/methscopolamine/pseudoephedrine 3.5 mg-1 mg-45 mg oral tablet, extended release

oral antihistamines d05539

68047027101 CoryZa-D dexchlorpheniramine/methscopolamine/pseudoephedrine 3.5 mg-1 mg-45 mg oral tablet, extended release

oral antihistamines d05539

68308018010 Durahist D dexchlorpheniramine/methscopolamine/pseudoephedrine 3.5 mg-1 mg-45 mg oral tablet, extended release

oral antihistamines d05539

51991018904 Duotan PD dexchlorpheniramine-pseudoephedrine 2.5 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04817

51991018916 Duotan PD dexchlorpheniramine-pseudoephedrine 2.5 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04817

59630046504 Tanafed DP dexchlorpheniramine-pseudoephedrine 2.5 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04817

59630046516 Tanafed DP dexchlorpheniramine-pseudoephedrine 2.5 mg-75 mg/5 mL oral suspension, extended release

oral antihistamines d04817

Page 158: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60258048016 SuTan dexchlorpheniramine-pseudoephedrine 3 mg-50 mg/5 mL oral suspension, extended release

oral antihistamines d04817

66869040710 AllerDur dexchlorpheniramine-pseudoephedrine 3 mg-50 mg/5 mL oral suspension, extended release

oral antihistamines d04817

00078043105 Focalin XR dexmethylphenidate 10 mg oral capsule, extended release oral amphetamines d04777

35356015930 Focalin XR dexmethylphenidate 10 mg oral capsule, extended release oral amphetamines d04777

35356015990 Focalin XR dexmethylphenidate 10 mg oral capsule, extended release oral amphetamines d04777

00078038205 Focalin dexmethylphenidate 10 mg oral tablet oral amphetamines d04777

00093527701 Dexmethylphenidate Hydrochloride dexmethylphenidate 10 mg oral tablet oral amphetamines d04777

00078049305 Focalin XR dexmethylphenidate 15 mg oral capsule, extended release oral amphetamines d04777

00078038005 Focalin dexmethylphenidate 2.5 mg oral tablet oral amphetamines d04777

00093527501 Dexmethylphenidate Hydrochloride dexmethylphenidate 2.5 mg oral tablet oral amphetamines d04777

00078043205 Focalin XR dexmethylphenidate 20 mg oral capsule, extended release oral amphetamines d04777

35356016030 Focalin XR dexmethylphenidate 20 mg oral capsule, extended release oral amphetamines d04777

35356016090 Focalin XR dexmethylphenidate 20 mg oral capsule, extended release oral amphetamines d04777

00078060805 Focalin XR dexmethylphenidate 25 mg oral capsule, extended release oral amphetamines d04777

00078043305 Focalin XR dexmethylphenidate 30 mg oral capsule, extended release oral amphetamines d04777

00078060905 Focalin XR dexmethylphenidate 35 mg oral capsule, extended release oral amphetamines d04777

00078043405 Focalin XR dexmethylphenidate 40 mg oral capsule, extended release oral amphetamines d04777

00078043005 Focalin XR dexmethylphenidate 5 mg oral capsule, extended release oral amphetamines d04777

35356015830 Focalin XR dexmethylphenidate 5 mg oral capsule, extended release oral amphetamines d04777

35356015890 Focalin XR dexmethylphenidate 5 mg oral capsule, extended release oral amphetamines d04777

00078038105 Focalin dexmethylphenidate 5 mg oral tablet oral amphetamines d04777

00093527601 Dexmethylphenidate Hydrochloride dexmethylphenidate 5 mg oral tablet oral amphetamines d04777

00007351359 Dexedrine Spansule dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

00406896101 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

Page 159: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00555095502 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

52054051309 Dexedrine Spansule dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

54868381100 Dexedrine Spansule dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

54868547900 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

54868547901 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

64720032809 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral capsule, extended release oral amphetamines d00804

00406895901 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral tablet oral amphetamines d00804

00527121901 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral tablet oral amphetamines d00804

00555095302 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral tablet oral amphetamines d00804

58177031204 Dextroamphetamine Sulfate dextroamphetamine 10 mg oral tablet oral amphetamines d00804

00007351459 Dexedrine Spansule dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

00406896201 Dextroamphetamine Sulfate dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

00555095602 Dextroamphetamine Sulfate dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

52054051409 Dexedrine Spansule dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

54868475800 Dexedrine Spansule dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

54868475801 Dexedrine Spansule dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

54868538800 Dextroamphetamine Sulfate dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

54868538801 Dextroamphetamine Sulfate dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

64720032909 Dextroamphetamine Sulfate dextroamphetamine 15 mg oral capsule, extended release oral amphetamines d00804

00007351220 Dexedrine Spansule dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

00007351259 Dexedrine Spansule dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

00406896001 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

00555095402 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

52054051209 Dexedrine Spansule dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

54868340200 Dexedrine Spansule dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

Page 160: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868340201 Dexedrine Spansule dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

64720032709 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral capsule, extended release oral amphetamines d00804

00007351920 Dexedrine dextroamphetamine 5 mg oral tablet oral amphetamines d00804

00406895801 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral tablet oral amphetamines d00804

00527114301 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral tablet oral amphetamines d00804

00555095202 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral tablet oral amphetamines d00804

54868340300 Dexedrine dextroamphetamine 5 mg oral tablet oral amphetamines d00804

58177031104 Dextroamphetamine Sulfate dextroamphetamine 5 mg oral tablet oral amphetamines d00804

13551070105 ProCentra dextroamphetamine 5 mg/5 mL oral solution oral amphetamines d00804

14629011716 Liquadd dextroamphetamine 5 mg/5 mL oral solution oral amphetamines d00804

23589003616 ProCentra dextroamphetamine 5 mg/5 mL oral solution oral amphetamines d00804

00247062320 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00247062377 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00472163004 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00472163016 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00603158654 Promethazine DM dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00603158658 Promethazine DM dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00904151600 Promethazine with Dextromethorphan dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00904151616 Promethazine with Dextromethorphan dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00904151628 Promethazine with Dextromethorphan dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

Page 161: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

21695069804 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

23490617801 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

23490617802 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

49999031404 Promethazine DM dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

50383080316 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

52959070004 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

52959070006 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

52959070008 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

54569105500 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

54868199000 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

54868199001 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

55887024704 Promethazine DM dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

60432060404 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

60432060416 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

63629158801 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

63629158802 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

Page 162: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63629158803 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

63874070712 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

63874070748 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

68115090004 Dextromethorphan-Promethazine dextromethorphan-promethazine 15 mg-6.25 mg/5 mL oral syrup oral antihistamines d03360

00140000601 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00140000614 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00140000635 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00172392760 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00172392770 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00172392780 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00182175701 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00182175705 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00182175710 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00182175789 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049300 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049301 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 163: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247049302 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049303 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049306 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049307 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049310 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049312 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049314 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049315 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049320 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049330 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049350 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049360 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00247049390 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00378047701 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00378047705 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00440737730 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 164: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00555016402 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00555016405 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00591562001 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00591562005 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00591562010 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321502 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321516 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321520 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321521 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321522 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321528 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00603321532 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00904588161 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

16590007130 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

16590007145 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

16590007160 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 165: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590007190 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

18837003830 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

18837003860 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

18837003890 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

18837003898 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

18837003899 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

21695026530 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490042803 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490042806 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541800 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541801 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541802 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541803 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541804 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541805 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

23490541806 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 166: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490541807 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010300 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010320 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010330 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010340 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010350 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010360 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

33358010390 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

35356000600 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002700 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002701 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002702 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002720 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002730 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002760 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

49999002790 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 167: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079028601 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51079028620 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51079028621 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51655083324 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51655083325 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51655083326 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

51655083382 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030600 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030602 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030605 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030606 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030610 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030615 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030620 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030628 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030630 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 168: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959030660 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

52959030690 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093600 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093602 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093603 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093604 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093605 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093606 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093607 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093608 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569093609 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569535403 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54569535404 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098700 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098701 Valium diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098800 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 169: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868098801 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098802 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098805 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

54868098809 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162400 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162401 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162402 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162404 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162405 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162406 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162408 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045162409 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045329901 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55045329909 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009202 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009206 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 170: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289009210 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009220 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009225 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009230 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009260 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009290 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55289009298 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052201 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052204 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052210 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052211 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052220 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052230 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052240 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052245 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052250 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 171: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887052260 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

55887052290 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027300 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027302 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027303 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027304 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027306 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027309 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027310 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027312 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027315 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027320 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027330 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027340 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027360 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027373 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 172: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016027389 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

58016027390 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63629152401 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63629152402 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63629152403 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63629152404 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63629152405 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022801 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022802 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022804 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022806 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022809 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022810 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022812 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022815 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022820 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 173: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874022828 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022830 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022840 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022860 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022872 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022874 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022877 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

63874022890 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006802 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006815 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006830 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006845 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006890 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66267006891 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66336003310 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66336003330 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 174: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336003344 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

66336003360 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

67544002015 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

67544002030 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

67544039530 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

67544072060 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009800 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009801 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009802 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009810 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009815 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009830 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009860 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009890 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009896 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68115009899 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

Page 175: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68387047530 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

68387047590 Diazepam diazepam 10 mg oral tablet oral long acting benzodiazepines d00148

00140000401 Valium diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00140000432 Valium diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00172392560 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00172392570 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093900 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093902 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093903 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093906 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093915 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00247093930 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00378027101 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00378027105 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00440737530 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00555016302 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

Page 176: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00555016305 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00591562101 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00591562105 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00591562110 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00603321316 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00603321320 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00603321321 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00603321328 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

16590006930 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

16590006960 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

16590006990 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

23490541901 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

23490541903 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

33358010130 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

51079028401 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

51079028420 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

Page 177: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079028421 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

52959029502 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

52959029510 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

52959029515 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

52959029530 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

52959029550 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54569094700 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54569094703 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54868212601 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54868212602 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54868212603 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

54868212604 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

55045121207 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

55045121208 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

55289097920 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

55289097930 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

Page 178: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289097960 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

55887063830 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

58016027420 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

58016027430 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63629294801 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022601 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022602 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022604 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022610 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022612 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022615 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022620 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022628 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022630 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022660 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

63874022690 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

Page 179: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267055030 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

68115009915 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

68115009930 Diazepam diazepam 2 mg oral tablet oral long acting benzodiazepines d00148

00140000501 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00140000514 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00140000535 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00172392660 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00172392670 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00172392680 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018700 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018701 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018702 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018703 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018704 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018705 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018706 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 180: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247018707 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018710 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018712 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018714 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018715 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018720 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018721 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018728 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018730 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018750 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018760 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018777 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018790 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247018798 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00247159610 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00378034501 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 181: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378034505 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00440737606 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00490004400 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00490004430 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00490004460 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00490004490 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00555036302 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00555036305 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00591561901 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00591561905 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00591561910 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321402 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321416 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321420 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321421 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321422 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 182: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603321428 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00603321432 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00615153301 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00615153310 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00615153332 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

00904588061 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

10544030930 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

10544040330 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

12280021900 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007010 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007020 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007030 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007060 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007071 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007072 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

16590007090 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 183: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

18837003903 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

18837003930 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

18837003960 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

18837003990 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026402 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026415 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026420 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026430 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026460 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

21695026490 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542001 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542002 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542003 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542004 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542005 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

23490542006 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 184: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490542007 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010212 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010215 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010220 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010230 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010260 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

33358010290 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

35356002200 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

43063001806 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001802 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001805 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001810 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001815 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001820 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001830 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

49999001860 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 185: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999001890 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

51079028501 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

51079028520 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

51079028521 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004701 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004702 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004703 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004705 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004706 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004710 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004712 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004715 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004720 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004721 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004725 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004730 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 186: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959004740 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004745 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004750 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004760 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

52959004790 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094800 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094900 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094901 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094902 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094903 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094904 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094905 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094906 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569094907 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569476400 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54569476403 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 187: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868005900 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005901 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005902 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005903 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005904 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005905 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005906 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005908 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868005909 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868070300 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868070301 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868070302 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

54868070303 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117100 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117101 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117102 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 188: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045117103 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117104 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117105 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117106 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117107 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117108 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045117109 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045328402 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045328403 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045328404 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55045328409 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009106 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009109 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009110 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009112 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009115 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 189: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289009121 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009130 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009160 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009190 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289009197 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289011706 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289011712 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55289011720 Valium diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068601 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068602 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068604 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068610 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068612 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068614 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068615 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068630 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 190: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887068640 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068660 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

55887068690 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027500 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027502 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027503 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027504 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027506 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027508 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027510 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027514 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027515 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027516 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027518 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027520 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027521 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 191: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016027524 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027528 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027530 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027536 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027540 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027550 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027560 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027573 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027589 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58016027590 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

58864014520 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

60760077510 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

60760077530 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072130 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072131 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072132 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 192: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392072139 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072145 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072151 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072154 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

61392072191 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152301 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152302 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152303 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152304 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152305 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63629152306 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63739007310 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022701 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022702 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022704 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022705 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 193: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874022706 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022708 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022709 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022710 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022712 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022714 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022715 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022716 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022718 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022720 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022721 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022724 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022728 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022730 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022736 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022740 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 194: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874022750 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022760 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022772 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022774 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022777 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022787 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

63874022790 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66267006903 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66267006960 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66267006990 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66267006991 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66336047802 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66336047806 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66336047810 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66336047815 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

66336047830 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 195: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

67544001915 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

67544034015 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

67544036815 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

67544043315 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68084035901 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68084035911 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010001 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010002 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010006 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010010 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010015 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010020 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010030 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010060 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68115010090 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

68387047430 Diazepam diazepam 5 mg oral tablet oral long acting benzodiazepines d00148

Page 196: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00054318863 Diazepam diazepam 5 mg/5 mL oral solution oral long acting benzodiazepines d00148

00054820716 Diazepam diazepam 5 mg/5 mL oral solution oral long acting benzodiazepines d00148

00054318544 Diazepam diazepam 5 mg/mL oral concentrate oral long acting benzodiazepines d00148

00115320001 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00115320003 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00143312601 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00143312610 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018800 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018802 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018803 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018804 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018806 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018810 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018812 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018814 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018815 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 197: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247018820 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018824 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018830 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00247018840 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00378161001 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00378161005 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00527058601 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00527058610 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00591079401 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00591079410 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00603326521 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00603326532 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00615032701 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00615032710 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

00904789680 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

10135052001 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 198: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

10135052010 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

16590007730 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

16590007760 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

16590007772 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

16590007790 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

21695021830 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

23490542801 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

23490542802 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

23490542803 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

43063011204 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

43063011206 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

49727005405 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

49999029120 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

51079011801 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

51079011820 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

52959016800 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 199: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959016830 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041700 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041702 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041703 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041704 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041706 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54569041707 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003300 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003302 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003303 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003305 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003306 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003307 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

54868003308 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55045219701 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55045219702 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 200: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045219705 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55045219706 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55045219708 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55045219709 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55289092320 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55289092330 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55887090915 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55887090930 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55887090960 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

55887090990 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

57866336703 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

58016070212 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

58016070230 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

58864015330 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

58914001210 Bentyl dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

60429015501 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 201: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60429015510 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046301 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046302 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046304 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046310 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046312 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046320 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046321 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046328 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046330 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046360 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

63874046390 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

66336091130 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

68115010620 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

68115010630 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

68115010660 Dicyclomine Hydrochloride dicyclomine 10 mg oral capsule oral gastrointestinal antispasmodics

d00999

Page 202: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247207930 Dicyclomine Hydrochloride dicyclomine 10 mg/5 mL oral syrup oral gastrointestinal antispasmodics

d00999

00603116158 Dicyclomine Hydrochloride dicyclomine 10 mg/5 mL oral syrup oral gastrointestinal antispasmodics

d00999

58914001516 Bentyl dicyclomine 10 mg/5 mL oral syrup oral gastrointestinal antispasmodics

d00999

00115322001 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00115322003 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00143122701 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00143122710 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058203 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058204 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058205 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058210 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058212 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058215 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058220 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058224 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00247058230 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

Page 203: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378162001 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00378162005 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00440738510 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00527128201 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00527128210 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00591079501 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00591079510 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00603326621 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00615151610 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00904019560 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

10135052101 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

23490543102 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

23490543103 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

23490543104 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

43063004504 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

43063004506 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

Page 204: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999008100 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

49999008120 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

49999008130 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

51079011901 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

51079011920 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

51655029324 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

52959022100 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

52959022120 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

52959022130 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

52959039030 Bentyl dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54569041800 Bentyl dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54569041900 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54569041902 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54569041904 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54569041907 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868039201 Bentyl dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

Page 205: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868081800 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868081801 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868081803 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868081805 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868081807 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

54868081808 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146701 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146702 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146703 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146706 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146708 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55045146709 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55289009515 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55289009517 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55289009520 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55289009530 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

Page 206: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289009560 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55887047016 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

55887047030 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

57866337701 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

57866337704 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

58016070300 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

58016070312 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

58016070330 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

58914001310 Bentyl dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

60429015601 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

60429015610 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

61392004145 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

61392004154 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

61392004156 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

61392004191 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

63629129901 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

Page 207: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267007430 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

68115010710 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

68115010715 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

68115010720 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

68115010730 Dicyclomine Hydrochloride dicyclomine 20 mg oral tablet oral gastrointestinal antispasmodics

d00999

00068069761 Tenuate diethylpropion 25 mg oral tablet oral amphetamines d00810

00147010910 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00147010920 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00147023710 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00147023720 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00182143601 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00247149521 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00247149530 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00527147501 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00591078301 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543401 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543402 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543403 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543404 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543405 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543406 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

23490543407 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

Page 208: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999092500 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

52637005210 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

52959015030 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

52959015090 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205903 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205904 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205905 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205907 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205908 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569205909 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54569512002 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54868146200 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

54868146201 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55045128300 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55045128308 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079401 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079407 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079414 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079421 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079428 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079430 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079456 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55289079493 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55887066915 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55887066921 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

Page 209: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887066930 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55887066960 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

55887066990 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

58016085600 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

58016085615 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

58016085621 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

58016085642 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

64720020810 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086414 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086428 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086430 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086442 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086460 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

66336086484 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

68115010914 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

68115010921 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

68115010930 Diethylpropion Hydrochloride diethylpropion 25 mg oral tablet oral amphetamines d00810

00068069861 Tenuate Dospan diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00068069862 Tenuate Dospan diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00182087001 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00182087002 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00247149430 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00527147701 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00591078201 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00904061860 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

Page 210: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904061870 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

21695087630 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

23490543501 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

23490543502 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

23490543503 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

23490543504 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

49999045728 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

52637005110 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

52959032914 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

52959032928 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

52959032930 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

52959032990 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

54569039600 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

54569039601 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

54569039605 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

54868146300 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55289036807 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55289036814 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55289036821 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55289036828 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55289036830 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55887065407 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55887065414 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55887065415 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

55887065430 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

Page 211: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887065460 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

58016083607 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

58016083614 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

58016083615 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

58016083630 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

63874026501 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

63874026520 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

66336068907 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

66336068914 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

66336068928 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

66336068930 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

68115011028 Diethylpropion Hydrochloride SR diethylpropion 75 mg oral tablet, extended release oral amphetamines d00810

00067614914 Triaminic Thin Strips Cough & Runny Nose

diphenhydrAMINE 12.5 mg oral disintegrating strip oral antihistamines d00212

00067614916 Triaminic Thin Strips Cough & Runny Nose

diphenhydrAMINE 12.5 mg oral disintegrating strip oral antihistamines d00212

00067635414 Triaminic Thin Strips Cough & Runny Nose

diphenhydrAMINE 12.5 mg oral disintegrating strip oral antihistamines d00212

00067638314 Triaminic Thin Strips Allergy diphenhydrAMINE 12.5 mg oral disintegrating strip oral antihistamines d00212

00045018018 Benadryl Fastmelt diphenhydrAMINE 12.5 mg oral tablet, chewable oral antihistamines d00212

00501201024 Benadryl diphenhydrAMINE 12.5 mg oral tablet, chewable oral antihistamines d00212

12547017238 Benadryl diphenhydrAMINE 12.5 mg oral tablet, chewable oral antihistamines d00212

50580034718 Benadryl Fastmelt diphenhydrAMINE 12.5 mg oral tablet, chewable oral antihistamines d00212

50580034818 Benadryl Children's Allergy Fastmelt diphenhydrAMINE 12.5 mg oral tablet, disintegrating oral antihistamines d00212

00071233317 Benadryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00113037926 Diphedryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

Page 212: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00121048905 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00121048910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00121048920 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00122081666 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00182200137 Genahist diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00182209537 Genahist diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00182606137 Hydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00182616837 Hydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00182616840 Hydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019805 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019820 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019830 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019860 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247019877 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247135030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247135052 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247135060 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00247135077 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00372004708 Scot-Tussin Allergy Relief Formula diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00372004716 Scot-Tussin Allergy Relief Formula diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00372004728 Scot-Tussin Allergy Relief Formula diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00436052504 Tusstat diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00436052516 Tusstat diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00436052528 Tusstat diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

Page 213: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00501205004 Benadryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00501205008 Benadryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00501205304 Benadryl Child Dye Free diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00536077058 Diphenhist diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00536077085 Diphenhist diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00536077097 Diphenhist diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00603082354 Q-Dryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00603082358 Q-Dryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00603082381 Q-Dryl A/F diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00603082394 Q-Dryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00603086054 Quenalin diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00904012309 Bydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00904012316 Bydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00904122800 Banophen diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00904122820 Banophen diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00904517416 Banophen diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

10892011265 Dytuss diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

10956062304 Calm-Aid diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

12547017055 Benadryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

12547017137 Benadryl Dye Free Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

17856082310 Q-Dryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

23490545501 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

24385037926 Diphedryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

37205056526 Complete Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

49348004534 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

Page 214: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49348004537 Allergy Relief (diphenhydramine HCl) diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

49348020537 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

49999024704 Hydramine diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057804 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057816 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057904 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057908 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057916 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383057928 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383058104 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50383058116 Child Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50428477072 Children's Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50428477073 Children's Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50580053404 Benadryl Children's Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

50580077704 PediaCare Children's Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

51641003046 DPH diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

51641003064 DPH diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

51641003076 DPH diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

51641003094 DPH diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

52183039904 PediaCare Children's Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

52959012303 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

52959012306 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54569320000 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54569419700 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

Page 215: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54838010300 Siladryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838010340 Siladryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838010380 Siladryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838013540 Siladryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838013570 Siladryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838013580 Siladryl Allergy diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838015440 Silphen Cough diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838015470 Silphen Cough diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54838015480 Silphen Cough diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54868122700 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

54868122702 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

55045125202 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

55887056204 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

58016401601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

59390006535 Altaryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

59390006546 Altaryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

59390006547 Altaryl diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

60432003304 Diphen AF diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

60432003308 Diphen AF diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

60432003316 Diphen AF diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

60432063408 Diphen Cough diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

66267097704 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

68115097604 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 12.5 mg/5 mL oral liquid oral antihistamines d00212

00501202220 Benadryl Children's Allergy Fastmelt diphenhydrAMINE 19 mg oral tablet, disintegrating oral antihistamines d00212

Page 216: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

10135041829 DiphenydrAMINE Quick Melt diphenhydrAMINE 19 mg oral tablet, disintegrating oral antihistamines d00212

00113046262 Diphedryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00182049210 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00182209201 Genahist diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00182209216 Genahist diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00185064801 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00185064810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007300 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007301 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007302 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007303 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007304 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007305 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007306 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007307 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007308 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007310 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007312 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007314 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007315 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007316 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007318 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007320 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007321 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007324 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 217: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247007325 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007340 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007360 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007390 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00247007399 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00440742516 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00501200024 Benadryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00501200048 Benadryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00501200124 Benadryl DF diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00536359401 Diphenhist diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00536359410 Diphenhist diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00536359435 Diphenhist diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603024018 Q-Dryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603024118 Q-Dryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603333721 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603333732 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603333921 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00603333932 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00904203524 Banophen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00904203559 Banophen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00904530660 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00904530661 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00904530680 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10135014901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 218: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

10135014910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10135014924 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10135014961 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10135016613 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10267083501 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

10267083504 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

12280006824 Benadryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

12280006830 Benadryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

16590007820 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

17714002001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

17714002010 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

21695030430 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

21695030490 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545700 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545701 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545702 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545703 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545704 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

23490545705 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

24385046262 Diphedryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

24385046278 Diphedryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

33358011030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

47682018232 Diphen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

47682018247 Diphen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

47682018264 Diphen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 219: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

47682084787 Diphen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

47682085887 Diphen diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49348004404 Valu-Dryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49348004410 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49348028208 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000300 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000306 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000315 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000320 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000321 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000324 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000340 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

49999000360 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

50428477070 Allergy diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

50428477071 Allergy diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

51655011354 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004300 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004304 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004310 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004315 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004320 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004324 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

52959004350 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 220: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959004360 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569023900 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569023901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569023902 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569023903 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569023908 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569350400 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54569350401 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54738011501 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54738011503 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54738011513 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002600 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002604 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002605 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002606 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

54868002607 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112500 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112501 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112502 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112503 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112504 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112505 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112506 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55045112508 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 221: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045112509 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047912 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047915 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047920 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047924 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047930 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55289047997 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55297092378 Diphedryl diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887088515 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887088530 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887097301 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887097320 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887097328 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887097330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

55887097390 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

57866359401 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

57866359402 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

57866359405 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

57866359406 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040800 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040806 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040809 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 222: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016040812 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040814 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040815 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040820 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040821 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040824 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040825 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040828 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040830 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040840 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58016040860 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58864016230 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58864016256 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

58864016260 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

60760033030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

61392022015 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

61392022045 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

61392022056 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

61392022091 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63629134301 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63629134302 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63629134303 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63629134304 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000501 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000502 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 223: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874000506 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000509 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000510 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000512 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000514 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000515 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000520 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000521 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000524 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000525 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000528 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000530 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000540 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000545 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000560 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

63874000590 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

65162051610 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

65162051611 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66267008015 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66267008020 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66267008030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66267008060 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66336058915 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66336058920 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66336058930 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

Page 224: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336058960 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66424002001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

66424002010 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011600 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011610 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011612 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011615 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011620 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011624 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011630 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68115011660 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

68387054130 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

70030046262 Antihistamine diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

70030047962 Antihistamine Allergy diphenhydrAMINE 25 mg oral capsule oral antihistamines d00212

00067614712 Theraflu Thin Strips Multi Symptom diphenhydrAMINE 25 mg oral disintegrating strip oral antihistamines d00212

00501204310 Benadryl Allergy diphenhydrAMINE 25 mg oral disintegrating strip oral antihistamines d00212

00501204320 Benadryl Allergy diphenhydrAMINE 25 mg oral disintegrating strip oral antihistamines d00212

00113040673 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00113047962 Diphedryl diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00122081566 Complete Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00182209116 Genahist diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00501200924 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00501200948 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00501200999 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

Page 225: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00536359701 Diphenhist diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036801 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036832 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00615036932 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00904555124 Banophen diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00904555159 Banophen diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

00927022124 Allermax diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015101 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015110 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015113 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015124 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015150 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015152 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10135015157 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10158004302 Nytol QuickCaps diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10158004304 Nytol QuickCaps diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10158004306 Nytol QuickCaps diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

10939056401 Antihistamine diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

12547017021 Benadryl Dye Free Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

12547017031 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

12547017033 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

12547017136 Benadryl Ultratab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

Page 226: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

17714004201 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

20254020706 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

20254020710 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

24385047962 Diphedryl diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

24385047978 Diphedryl diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

43292055631 Aler-Tab diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

49348037508 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

49348037510 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

49348047104 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

49348056404 Valu-Dryl diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

49348056407 Valu-Dryl diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50428477066 Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50428477068 Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50428477069 Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084310 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084313 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084324 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084325 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084348 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

50580084372 Simply Sleep diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

51079096701 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

51079096719 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

51079096720 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

51655011324 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

51655011380 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

Page 227: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52389061060 Tranquil diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

53100012822 Sominex diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

53100012832 Sominex diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

53746006410 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

60814010430 Complete Allergy diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

65162015610 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

65162015611 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

66375010702 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

66553001001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 25 mg oral tablet oral antihistamines d00212

63717057106 Dytan diphenhydrAMINE 25 mg oral tablet, chewable oral antihistamines d00212

68032018960 Diphenmax diphenhydrAMINE 25 mg oral tablet, chewable oral antihistamines d00212

41167000140 Unisom SleepMelts diphenhydrAMINE 25 mg oral tablet, disintegrating oral antihistamines d00212

63717057004 Dytan diphenhydrAMINE 25 mg/5 mL oral liquid oral antihistamines d00212

68308012204 Ben-Tann diphenhydrAMINE 25 mg/5 mL oral liquid oral antihistamines d00212

00182013510 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00182113193 Nightime Sleepaid diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00185064901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00185064910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012000 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012002 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012003 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012004 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012005 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012006 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 228: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247012007 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012008 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012010 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012012 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012014 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012015 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012020 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012024 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00247012030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00501600008 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00501600016 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00501600032 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00555005902 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00555005905 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00603333821 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00603333832 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00603334021 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00603334032 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00904205661 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00904530760 Banophen diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00904530780 Banophen diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10135015601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10135015610 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 229: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

10135015613 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10267083601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10267083604 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10956060124 Sleep-ettes diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

10956060148 Sleep-ettes diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

12280018500 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

16590007920 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

17714002101 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

17714002110 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

18837004330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

23490545901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

23490545902 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

23490545903 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

23490545904 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

33358011120 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

33358011130 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

41157000611 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

41167000610 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

41167000613 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

43063017906 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49348007403 Sleep Aid (Diphenhydramine) diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49348007406 Sleep Aid (Diphenhydramine) diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49999009104 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 230: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999009115 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49999009120 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49999009130 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

49999009160 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

50486061616 Sleepinal diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

50486061632 Sleepinal diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

50486062116 Sleepinal diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

51079006601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

51079006619 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

51079006620 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005306 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005310 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005312 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005315 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005320 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005330 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

52959005352 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54569024100 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54569024102 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54569024103 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54569024104 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54569024105 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54738011601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54738011603 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54738011613 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 231: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868105000 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54868105001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54868105003 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54868105004 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

54868105005 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112400 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112401 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112402 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112403 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112404 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112405 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112406 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112407 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112408 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55045112409 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010001 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010010 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010015 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010020 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010030 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

55289010040 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

57866376201 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

57866376202 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

57866376204 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

57866376205 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 232: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016040900 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040910 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040912 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040915 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040920 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040924 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040930 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040940 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040960 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

58016040990 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

60242020201 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

60242020210 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

61392022345 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

61392022354 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

61392022356 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

61392022391 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63629134901 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63629134902 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63629134903 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000601 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000602 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000607 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000610 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000612 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000614 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 233: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874000615 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000620 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000625 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000628 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000630 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

63874000660 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

65162051810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

65162051811 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66267008115 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66267008120 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66267008130 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66267008160 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66336004506 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66336004515 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66336004530 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66336004560 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66424002101 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

66424002110 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

68115011706 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

68115011715 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

68115011720 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

68115011730 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

74300000133 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

74300000610 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

Page 234: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

74300000611 Unisom Sleepgels Maximum Strength diphenhydrAMINE 50 mg oral capsule oral antihistamines d00212

00536377206 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

00927061634 Twilite diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956060724 Aler-Dryl diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956060748 Aler-Dryl diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956061024 Calm-Aid diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956061048 Calm-Aid diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956075024 Sleep-ettes D diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

10956075048 Sleep-ettes D diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

20254020806 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

20254020810 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

43292055765 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

53100012875 Sominex Maximum Strength Caplet diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

66375010802 DiphenhydrAMINE Hydrochloride diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

75137021203 Compoz Nighttime Sleep Aid diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

75137021212 Compoz Nighttime Sleep Aid diphenhydrAMINE 50 mg oral tablet oral antihistamines d00212

51991029816 Rindal HPD diphenhydrAMINE/HYDROcodone/phenylephrine 12.5 mg-2 mg-7.5 mg/5 mL oral syrup

oral antihistamines d04925

60258070916 Hydro-DP diphenhydrAMINE/HYDROcodone/phenylephrine 12.5 mg-2 mg-7.5 mg/5 mL oral syrup

oral antihistamines d04925

66346012165 Endal HD diphenhydrAMINE/HYDROcodone/phenylephrine 12.5 mg-2 mg-7.5 mg/5 mL oral syrup

oral antihistamines d04925

60258071116 Gestuss-HC diphenhydrAMINE/HYDROcodone/phenylephrine 12.5 mg-3.5 mg-5 mg/5 mL oral syrup

oral antihistamines d04925

66346019165 Tussinate diphenhydrAMINE/HYDROcodone/phenylephrine 12.5 mg-3.5 mg-5 mg/5 mL oral syrup

oral antihistamines d04925

Page 235: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63717071004 Dytan-HC diphenhydrAMINE/HYDROcodone/phenylephrine 25 mg-3.5 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04925

68308013404 D-Tann HC diphenhydrAMINE/HYDROcodone/phenylephrine 25 mg-3.5 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04925

00067024617 Doans PM diphenhydrAMINE-magnesium salicylate 25 mg-580 mg oral tablet oral antihistamines d04175

00067618020 Doans PM diphenhydrAMINE-magnesium salicylate 25 mg-580 mg oral tablet oral antihistamines d04175

00067635614 Triaminic Night Time Cold & Cough diphenhydrAMINE-phenylephrine 12.5 mg-5 mg oral disintegrating strip

oral antihistamines d04861

65224054501 Aldex-CT diphenhydrAMINE-phenylephrine 12.5 mg-5 mg oral tablet, chewable, extended release

oral antihistamines d04861

50580055204 PediaCare Children's Allergy & Cold diphenhydrAMINE-phenylephrine 12.5 mg-5 mg/5 mL oral liquid oral antihistamines d04861

50580078104 Benadryl-D Children's Allergy & Sinus diphenhydrAMINE-phenylephrine 12.5 mg-5 mg/5 mL oral liquid oral antihistamines d04861

52183038904 PediaCare Children's Allergy & Cold diphenhydrAMINE-phenylephrine 12.5 mg-5 mg/5 mL oral liquid oral antihistamines d04861

63824018464 Delsym Children's Nighttime Cough and Cold

diphenhydrAMINE-phenylephrine 12.5 mg-5 mg/5 mL oral liquid oral antihistamines d04861

63824018764 Delsym Children's Nighttime Cough and Cold

diphenhydrAMINE-phenylephrine 12.5 mg-5 mg/5 mL oral liquid oral antihistamines d04861

63717057706 Dytan-D diphenhydrAMINE-phenylephrine 25 mg-10 mg oral tablet, chewable, extended release

oral antihistamines d04861

68032020560 Diphenmax D diphenhydrAMINE-phenylephrine 25 mg-10 mg oral tablet, chewable, extended release

oral antihistamines d04861

68308052660 D-Tann diphenhydrAMINE-phenylephrine 25 mg-10 mg oral tablet, chewable, extended release

oral antihistamines d04861

13811007316 Zoden PD diphenhydrAMINE-phenylephrine 25 mg-7.5 mg/5 mL oral liquid oral antihistamines d04861

50991060716 Alahist LQ diphenhydrAMINE-phenylephrine 25 mg-7.5 mg/5 mL oral liquid oral antihistamines d04861

Page 236: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00677191441 Diphentann-D diphenhydrAMINE-phenylephrine 25 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04861

63717057604 Dytan-D diphenhydrAMINE-phenylephrine 25 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04861

68308012604 D-Tann diphenhydrAMINE-phenylephrine 25 mg-7.5 mg/5 mL oral suspension, extended release

oral antihistamines d04861

00031224713 Dimetapp Nighttime Cold & Congestion diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00031869812 Robitussin Night Time Cough & Cold diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00031869813 Robitussin Night Time Cough & Cold diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00031870112 Robitussin Night Time Cough & Cold Pediatric

diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00031871512 Robitussin Night Time Cough & Cold Children's

diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00067634404 Triaminic Night Time Cold & Cough diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00067634408 Triaminic Night Time Cold & Cough diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

50428477084 Children's Triacting Night Time diphenhydrAMINE-phenylephrine 6.25 mg-2.5 mg/5 mL oral liquid oral antihistamines d04861

00043620404 Triaminic Night Time Cold & Cough diphenhydrAMINE-phenylephrine 6.25 mg-6.25 mg/5 mL oral liquid

oral antihistamines d04861

00043620408 Triaminic Night Time Cold & Cough diphenhydrAMINE-phenylephrine 6.25 mg-6.25 mg/5 mL oral liquid

oral antihistamines d04861

00501202020 Benadryl Childrens Allergy and Cold diphenhydrAMINE-pseudoephedrine 12.5 mg-30 mg oral tablet, disintegrating

oral antihistamines d03312

00071255517 Benadryl Allergy Decongestant diphenhydrAMINE-pseudoephedrine 12.5 mg-30 mg/5 mL oral liquid

oral antihistamines d03312

00501204104 Benadryl Child Allergy and Sinus diphenhydrAMINE-pseudoephedrine 12.5 mg-30 mg/5 mL oral liquid

oral antihistamines d03312

Page 237: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00501206104 Benadryl Child Allergy and Sinus diphenhydrAMINE-pseudoephedrine 12.5 mg-30 mg/5 mL oral liquid

oral antihistamines d03312

00067029724 Tavist NightTime Allergy diphenhydrAMINE-pseudoephedrine 25 mg-60 mg oral tablet oral antihistamines d03312

00115107001 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00115107003 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00406218701 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00406218710 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00527146101 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00527146110 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00555025202 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00555025205 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00597001701 Persantine dipyridamole 25 mg oral tablet oral vasodilators d00213

00904108360 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00904108380 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00904108660 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00904108661 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

10135053610 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

50268026315 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

51079006801 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

51079006820 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

52152026502 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

52152026505 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

54569046600 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

54868004201 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

54868004204 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

Page 238: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868128800 Persantine dipyridamole 25 mg oral tablet oral vasodilators d00213

55289074897 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

61392054934 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

61392054945 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

61392054956 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

61392054991 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

64980013301 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

64980013310 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

68382018701 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

68382018710 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

68462011601 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

68462011610 Dipyridamole dipyridamole 25 mg oral tablet oral vasodilators d00213

00115107101 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00115107103 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00247106930 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00406218801 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00406218810 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00527146201 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00527146210 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00555028502 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00555028505 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00597001801 Persantine dipyridamole 50 mg oral tablet oral vasodilators d00213

00615157301 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00615157310 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00615157332 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

Page 239: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904108760 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00904108761 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00904108780 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

10135053710 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

50268026415 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

51079006901 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

51079006920 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

52152026602 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

52152026605 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

54569046801 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

54868004300 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

54868004301 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

54868004302 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

54868004303 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

61392055231 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

61392055245 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

61392055256 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

64980013401 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

64980013410 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

68382018801 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

68382018810 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

68462011701 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

68462011710 Dipyridamole dipyridamole 50 mg oral tablet oral vasodilators d00213

00115107201 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00115107203 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

Page 240: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00406218901 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00406218910 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00527146301 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00527146310 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00555028602 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00555028605 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00597001901 Persantine dipyridamole 75 mg oral tablet oral vasodilators d00213

00615157401 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00615157405 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00615157410 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00615157432 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00904108860 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00904108861 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00904108880 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

10135053810 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

50268026515 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

51079007001 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

51079007020 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

54569047000 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

54868004400 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

54868004402 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

64980013501 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

64980013510 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

68115066300 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

68382018901 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

Page 241: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68382018910 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

68462011801 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

68462011810 Dipyridamole dipyridamole 75 mg oral tablet oral vasodilators d00213

00615158601 Ergoloid Mesylates ergoloid mesylates 0.5 mg sublingual tablet sublingual vasodilators d00902

00615158613 Ergoloid Mesylates ergoloid mesylates 0.5 mg sublingual tablet sublingual vasodilators d00902

00182105901 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00182105910 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00182151805 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00247146903 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00615158501 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00615158505 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00615158510 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00904033660 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

53489028101 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

53489028105 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

53489028110 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

54868089900 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011130 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011131 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011132 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011139 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011145 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011151 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011154 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011160 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

Page 242: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392011190 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

61392011191 Ergoloid Mesylates ergoloid mesylates 1 mg oral tablet oral vasodilators d00902

00615158701 Ergoloid Mesylates ergoloid mesylates 1 mg sublingual tablet sublingual vasodilators d00902

00615158705 Ergoloid Mesylates ergoloid mesylates 1 mg sublingual tablet sublingual vasodilators d00902

00615158710 Ergoloid Mesylates ergoloid mesylates 1 mg sublingual tablet sublingual vasodilators d00902

00615158713 Ergoloid Mesylates ergoloid mesylates 1 mg sublingual tablet sublingual vasodilators d00902

61570007201 Menest esterified estrogens 0.3 mg oral tablet oral estrogens d00542

54868593400 Menest esterified estrogens 0.625 mg oral tablet oral estrogens d00542

54868593401 Menest esterified estrogens 0.625 mg oral tablet oral estrogens d00542

58864095130 Menest esterified estrogens 0.625 mg oral tablet oral estrogens d00542

61570007301 Menest esterified estrogens 0.625 mg oral tablet oral estrogens d00542

61570007401 Menest esterified estrogens 1.25 mg oral tablet oral estrogens d00542

61570007550 Menest esterified estrogens 2.5 mg oral tablet oral estrogens d00542

00032102301 Estratest H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

00527141001 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

00527141010 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

10135046901 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

11528002001 Covaryx HS esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

15310002001 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

50220000101 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

51991007801 EEMT HS esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

Page 243: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

53746007701 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

54569435401 Estratest H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

54868356400 Estratest H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

54868356401 Estratest H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

54868356402 Estratest H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

62559150700 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

65162087710 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

66993092102 Essian H.S. esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

68462017301 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 0.625 mg-1.25 mg oral tablet

oral estrogens d03245

00032102601 Estratest esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

00032102610 Estratest esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

00527140901 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

00527140910 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

10135047001 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

11528001001 Covaryx esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

15310001001 EEMT esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

Page 244: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50220000201 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

51991007901 EEMT DS esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

53746007801 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868356500 Estratest esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868356501 Estratest esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868356502 Estratest esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868477100 Syntest DS esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868477101 Syntest DS esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

54868477102 Syntest DS esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

55045348001 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

62559149000 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

65162087810 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

66993092002 Essian esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

68462017401 Esterified Estrogens-MethylTESTOSTERone

esterified estrogens-methylTESTOSTERone 1.25 mg-2.5 mg oral tablet

oral estrogens d03245

00009377201 Ogen 0.625 estropipate 0.75 mg oral tablet oral estrogens d00543

00182197601 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

00247215630 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

00339598112 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

Page 245: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378455101 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

00555072702 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

00591041401 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

23490690601 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

52959032610 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

54569852500 Ogen 0.625 estropipate 0.75 mg oral tablet oral estrogens d00543

54868126200 Ogen 0.625 estropipate 0.75 mg oral tablet oral estrogens d00543

54868126201 Ogen 0.625 estropipate 0.75 mg oral tablet oral estrogens d00543

54868126202 Ogen 0.625 estropipate 0.75 mg oral tablet oral estrogens d00543

54868311400 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

54868311401 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

55887032430 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

66336097730 Estropipate estropipate 0.75 mg oral tablet oral estrogens d00543

00009377301 Ogen 1.25 estropipate 1.5 mg oral tablet oral estrogens d00543

00182197701 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

00339598312 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

00378455301 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

00555072802 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

00591041501 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

51285001102 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

54569855100 Ogen 1.25 estropipate 1.5 mg oral tablet oral estrogens d00543

54868126100 Ogen 1.25 estropipate 1.5 mg oral tablet oral estrogens d00543

54868414900 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

54868414901 Estropipate estropipate 1.5 mg oral tablet oral estrogens d00543

00009377401 Ogen 2.5 estropipate 3 mg oral tablet oral estrogens d00543

Page 246: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00182197801 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

00339598512 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

00555072902 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

00591041601 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

54868365300 Ogen 2.5 estropipate 3 mg oral tablet oral estrogens d00543

54868476101 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

54868476102 Estropipate estropipate 3 mg oral tablet oral estrogens d00543

00143336701 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00143336705 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00187405110 Dalmane flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043000 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043002 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043003 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043004 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043006 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043007 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043008 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043010 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043015 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

Page 247: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247043020 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00247043098 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00378441501 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00378441505 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

23490561003 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

23490561006 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

33358014630 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

33358014660 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

51079030201 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

51079030220 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

51655082524 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

52959036900 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

52959036906 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

52959036930 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

52959036940 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

52959036960 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

Page 248: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569237602 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

54868009201 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

54868009202 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147700 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147701 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147703 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147704 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147706 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147707 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147708 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55045147709 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55887017030 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55887017060 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

55887017090 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

58016081105 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

58016081114 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

Page 249: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016081115 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

58016081130 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

58016081140 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

58016081160 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

60429054201 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

60429054205 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023830 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023831 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023832 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023839 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023845 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023851 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023854 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023856 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023860 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

61392023890 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

Page 250: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392023891 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63629303401 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63629303402 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021301 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021305 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021312 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021315 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021320 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021330 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021340 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

63874021360 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

67544075230 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

68071022030 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

68115040100 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

68115040120 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

68115040130 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

Page 251: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115040160 Flurazepam Hydrochloride flurazepam 15 mg oral capsule oral long acting benzodiazepines d00238

00143337001 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00143337005 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00182181801 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00182181805 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00187405210 Dalmane flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034500 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034502 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034503 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034507 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034510 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034515 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034520 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034530 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00247034598 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00378443001 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 252: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378443005 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00615046147 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00904280140 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00904280161 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

12280000600 Dalmane flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

21695036330 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

23490561103 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

23490561106 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

33358014730 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

33358014760 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

51079030301 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

51079030320 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

51079030321 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

52959023614 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

52959023615 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

52959023620 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 253: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959023630 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

52959023660 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

54569089800 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

54868009300 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

54868009301 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

54868067501 Dalmane flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192200 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192202 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192204 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192206 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192208 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55045192209 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55289003830 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55887018530 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55887018560 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

55887018590 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 254: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016081200 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081202 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081203 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081206 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081209 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081210 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081212 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081214 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081215 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081220 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081221 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081224 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081230 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081260 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081273 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

58016081289 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 255: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60429054301 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

60429054305 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024130 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024131 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024132 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024139 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024145 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024151 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024154 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024156 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024160 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024190 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

61392024191 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63629320001 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021401 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021406 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 256: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874021409 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021410 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021412 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021414 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021415 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021420 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021421 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021424 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021430 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

63874021460 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

66267033115 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

66267033130 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

66267033145 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

67544078530 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68071022020 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68115014600 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

Page 257: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115014614 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68115014630 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68115014648 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68115014660 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68387061015 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

68387061030 Flurazepam Hydrochloride flurazepam 30 mg oral capsule oral long acting benzodiazepines d00238

00182149205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00182149210 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012703 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012710 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012712 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012715 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012720 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012730 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00247012750 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00378258601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00378258610 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00440761630 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00591552201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00591552205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00603396721 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00603396728 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

Page 258: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603396732 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00615152513 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00904035740 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00904035760 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00904035780 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

10702001001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

10702001010 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

10702001050 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

16714008104 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

16714008105 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

18837007030 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

23155010501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

23155010510 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

23490572701 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

23490572702 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

23629002901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

33358017930 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

35356012360 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

50111030701 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

50111030702 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

50111030703 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51079041301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51079041320 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51079053001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51079053020 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

Page 259: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079079601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51079079620 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

51655007854 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52152031102 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52152031105 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52959048110 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52959048112 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52959048120 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

52959048130 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54569040600 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54569040601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54569040603 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54569040605 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54868022901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54868022902 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54868022903 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

54868022904 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55045180508 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55289091201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55289091210 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55289091230 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55289091260 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55887023201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55887023215 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55887023220 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

Page 260: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887023260 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

55887023290 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

57866387501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

57866387504 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

58016040500 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

58016040506 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

58016040515 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

58016040520 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

58016040530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

60760030720 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

61392001234 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

61392001245 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

61392001256 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

61392001291 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

63629175101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

63629175102 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

63739048310 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

63874030330 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

66267011215 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

66267011230 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

66267011260 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

66336079515 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

67405057510 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

67405057550 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

67405057596 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

Page 261: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68084025301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68084025311 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68115017400 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68115017415 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68115017430 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68462036001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

68462036005 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg oral tablet oral antihistamines d00907

00182137640 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00247033205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00247033210 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00247033238 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00247033252 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00247033260 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00603131054 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00603131058 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

10702005216 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

23490572801 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

33358018001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

50383079616 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

52959058203 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

54569164001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

54868203200 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

54868433600 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

58016484501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

60432015004 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

Page 262: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60432015016 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

63629185501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

63629185502 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

63874071812 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 10 mg/5 mL oral syrup oral antihistamines d00907

00182149301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010500 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010502 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010503 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010504 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010505 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010506 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010507 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010508 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010510 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010512 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010514 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010515 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010520 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010521 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010524 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00247010535 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00378258701 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00378258710 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 263: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00591552301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00591552305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00591552310 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00603396821 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00603396828 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00603396832 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00615152663 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00904035840 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00904035860 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00904035880 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

10702001101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

10702001110 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

10702001150 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16590012220 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16590012230 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16590012240 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16590012260 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16590012290 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16714008204 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16714008205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

16714008206 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

21695020820 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

21695020830 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

21695020860 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

21695020890 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 264: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23155010601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23155010610 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572902 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572903 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572904 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572905 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23490572906 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

23629003001 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

33358018120 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

33358018130 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

43063009506 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

49999002400 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

49999002412 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

49999002424 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

49999002430 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

49999002460 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

50111030801 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

50111030802 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

50111030803 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

51079053101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

51079053120 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

51079080601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

51079080620 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

51655007980 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 265: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52152031202 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52152031205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007412 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007413 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007415 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007416 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007420 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007421 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007424 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007430 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007440 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007450 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007460 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

52959007490 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

53489012701 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

53489012705 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

53489012710 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041300 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041304 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041306 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041308 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569041309 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54569482500 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 266: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569482501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54738030803 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006300 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006302 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006303 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006306 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006307 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

54868006309 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55045144605 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55045144607 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55045144608 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013906 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013910 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013912 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013920 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013930 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013940 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013960 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55289013997 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55887098510 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55887098515 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55887098521 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 267: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887098530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

55887098590 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

57866387401 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

57866387403 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

57866387404 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

57866387406 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040600 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040612 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040615 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040620 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040630 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040640 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58016040660 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58864004520 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58864004530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58864004542 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

58864004560 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

60760097130 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

61392001315 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

61392001345 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

61392001356 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

61392001391 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63739048610 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030320 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030401 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 268: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874030402 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030409 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030410 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030412 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030414 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030415 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030420 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030425 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030428 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030430 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030440 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030445 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030460 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

63874030490 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

66336008615 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

66336008620 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

66336008630 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

67405067110 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

67405067150 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

67405067196 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68084025401 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68084025411 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68115017512 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68115017515 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68115017520 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

Page 269: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115017530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68115017560 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68462036101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

68462036105 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 25 mg oral tablet oral antihistamines d00907

00182149405 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107401 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107402 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107403 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107406 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107420 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247107430 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00378258801 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00378258810 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00591342301 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00591342305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00591342310 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00603396921 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00603396928 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00904035940 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00904035960 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

10702001201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

10702001210 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

10702001250 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

16714008304 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

16714008305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

Page 270: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

21695035660 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

23155010701 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

23155010710 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

23490573100 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

23490573101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

23629003101 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

49999003524 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

49999003530 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

49999003560 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

50111030901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

50111030902 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

50111030903 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

51079053201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

51079053220 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

51079081601 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

51079081620 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

52152031302 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

52152031305 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

52959088230 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

53489012801 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

53489012805 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

53489012810 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54569040901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54569040903 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54569040904 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

Page 271: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54738030901 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54868180400 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54868180402 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

54868180404 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013801 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013812 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013817 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013820 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013825 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55289013830 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

55887094215 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

57664011408 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

57664011418 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

57866387602 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

57866387603 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

57866387604 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

58016045200 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

58016045220 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

58016045230 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

61392012245 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

61392012251 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

61392012254 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

61392012291 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

63874007730 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

63874007750 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

Page 272: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336079630 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

67405057710 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

67405057750 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68084025501 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68084025511 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68115017600 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68115017630 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68115017860 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68462036201 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

68462036205 HydrOXYzine Hydrochloride hydrOXYzine hydrochloride 50 mg oral tablet oral antihistamines d00907

00247202001 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

00247202002 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

00555032402 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

49999003612 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

49999003660 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

54868410800 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

54868410900 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

68387046930 HydrOXYzine Pamoate hydrOXYzine pamoate 100 mg oral capsule oral antihistamines d00907

00069541066 Vistaril hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00185061301 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00185061305 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116701 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116702 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116703 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116704 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

Page 273: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247116706 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116710 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116712 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116715 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116724 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00247116730 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00555032302 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00555032304 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00591080001 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00591080005 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

00615033163 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

10544032830 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

16590035709 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

16590035712 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

16590035720 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

16590035730 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

21695057320 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

23490573301 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

23490573302 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

23629003201 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

33358018220 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

33358018230 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

51079007720 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

51655053352 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043310 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

Page 274: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959043315 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043320 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043330 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043340 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043350 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

52959043360 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54569235302 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54569235303 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54569235305 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54868016901 Vistaril hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54868289200 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54868289202 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54868289203 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

54868289204 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219502 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219504 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219505 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219506 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219507 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219508 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55045219509 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55289022610 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55289022615 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55289022630 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55887042210 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

Page 275: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887042230 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55887042260 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

55887042290 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

57866389301 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

57866389302 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

57866389303 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025900 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025902 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025910 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025920 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025930 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025950 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025960 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

58016025990 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012330 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012331 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012332 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012339 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012345 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012351 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012354 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012360 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012390 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

61392012391 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

62584073901 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

Page 276: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

62584073911 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63629153301 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63629153302 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044202 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044203 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044204 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044205 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044209 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044210 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044214 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044215 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044220 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044225 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044228 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044230 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044240 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044245 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044260 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

63874044290 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

66336020820 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

66336020830 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

67544079130 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

68115017700 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

68115017730 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

68115017760 HydrOXYzine Pamoate hydrOXYzine pamoate 25 mg oral capsule oral antihistamines d00907

Page 277: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00069544093 Vistaril hydrOXYzine pamoate 25 mg/5 mL oral suspension oral antihistamines d00907

00069544097 Vistaril hydrOXYzine pamoate 25 mg/5 mL oral suspension oral antihistamines d00907

00069542066 Vistaril hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00185061501 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00185061505 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00247116801 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00247116802 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00247116804 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00247116820 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00247116830 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00555030202 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00555030204 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00591080101 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00591080105 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00615033213 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

00615033263 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

23629003301 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

51079007801 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

51079007820 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

52959083306 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

52959083320 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

54569257101 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

54868185400 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

54868185401 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

54868185403 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

Page 278: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868185404 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166100 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166101 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166102 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166103 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166106 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55045166108 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55289019510 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

55289035410 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

57866389401 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

57866389402 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

57866389403 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

58016046410 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

58016046415 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

58016046420 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

58016046430 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

61392001015 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

61392001045 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

61392001056 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

61392001091 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

62584074101 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

62584074111 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075701 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075704 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075710 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

Page 279: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874075715 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075720 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075721 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075724 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075728 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075730 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075760 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

63874075790 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

66336079760 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

68115017820 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

68387046830 HydrOXYzine Pamoate hydrOXYzine pamoate 50 mg oral capsule oral antihistamines d00907

15456090990 Prosed EC hyoscyam/methenam/methylene blue/phenyl salic 0.06 mg-81.6 mg-10.8 mg-36.2 mg oral enteric coated tablet

oral belladonna alkaloids d03618

60258051709 Uritact-EC hyoscyam/methenam/methylene blue/phenyl salic 0.06 mg-81.6 mg-10.8 mg-36.2 mg oral enteric coated tablet

oral belladonna alkaloids d03618

63717051201 Utira hyoscyam/methenam/methylene blue/phenyl salic 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral enteric coated tablet

oral belladonna alkaloids d03618

00091353101 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00091353105 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067906 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067910 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067912 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067920 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067930 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247067960 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247086105 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

Page 280: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247086112 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247086121 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00247086130 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00574024601 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

00904249660 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

10267162101 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

23629003401 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

24486060510 HyoMax hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

43199001301 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

51285093205 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

51991032501 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

52152014302 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

52959017502 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

52959017530 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54569042800 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54569376302 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868155502 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220900 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220902 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220903 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220904 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220905 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220906 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

54868220907 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55289095620 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

Page 281: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289095660 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55887048310 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55887048321 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55887048325 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55887048330 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

55887048390 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

58177027404 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

59743002601 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

62175010101 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

68013001101 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

68115067800 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

68220011210 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

68220011250 Levsin hyoscyamine 0.125 mg oral tablet oral belladonna alkaloids d00985

68220011810 NuLev hyoscyamine 0.125 mg oral tablet, chewable oral belladonna alkaloids d00985

00091311101 Nulev hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

00225029515 Anaspaz hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

00225029520 Anaspaz hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

00485008201 Ed Spaz hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

00574024701 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

24486060310 HyoMax FT hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

43199001201 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

54868345100 Anaspaz hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

58177042304 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

64543011401 Symax FasTab hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

68013000501 Hyoscyamine Sulfate hyoscyamine 0.125 mg oral tablet, disintegrating oral belladonna alkaloids d00985

Page 282: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00091353201 Levsin SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

00091353205 Levsin SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

00574025001 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

00904512060 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

10267273401 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

24486060110 HyoMax SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

43063032160 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

43199001101 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

51285093505 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

51991065601 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

52152015502 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

54868176700 Levsin SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

54868311600 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

55045267500 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

55887076020 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

55887076021 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

55887076060 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

58177025504 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

62175010201 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

64543011101 Symax SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

68013001801 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

68013001890 Hyoscyamine Sulfate hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

68220011310 Levsin SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

68220011350 Levsin SL hyoscyamine 0.125 mg sublingual tablet sublingual belladonna alkaloids d00985

00091453216 Levsin hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

Page 283: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00182613640 Hyoscyamine Sulfate hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

00247086052 Hyoscyamine Sulfate hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

00603131558 Hyoscyamine Sulfate hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

54838051180 Hyosyne hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

60258080116 Hyoscyamine Sulfate hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

62175010416 Hyoscyamine Sulfate hyoscyamine 0.125 mg/5 mL oral liquid oral belladonna alkaloids d00985

00091453815 Levsin hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

00603131473 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

23490574001 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

54838050615 Hyosyne hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

54868566100 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

60258080215 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

60432010315 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

62175010515 Hyoscyamine Sulfate hyoscyamine 0.125 mg/mL oral solution oral belladonna alkaloids d00985

66934020030 IB-Stat hyoscyamine 0.125 mg/mL oral spray oral belladonna alkaloids d00985

51991013501 Hyospaz hyoscyamine 0.15 mg oral tablet oral belladonna alkaloids d00985

57866902801 Hyoscyamine Sulfate hyoscyamine 0.15 mg oral tablet oral belladonna alkaloids d00985

61451222501 Cystospaz hyoscyamine 0.15 mg oral tablet oral belladonna alkaloids d00985

66993040202 Hyoscyamine Sulfate hyoscyamine 0.15 mg oral tablet oral belladonna alkaloids d00985

24486060490 HyoMax DT hyoscyamine 0.375 mg dual-release oral tablet, extended release oral belladonna alkaloids d00985

64543011890 Symax Duotab hyoscyamine 0.375 mg dual-release oral tablet, extended release oral belladonna alkaloids d00985

68032025190 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg dual-release oral tablet, extended release oral belladonna alkaloids d00985

00091353701 Levsinex SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

Page 284: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00091353705 Levsinex SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

00603400521 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

00904783360 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

51285093802 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

52152016302 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

54569349600 Levsinex SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

54868321501 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

54868321502 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

54868321503 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

55887052820 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

55887052830 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

55887052860 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

58177001704 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral capsule, extended release oral belladonna alkaloids d00985

00091353801 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00091353805 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00247177206 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00247177210 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00574025101 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00603400421 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00904538760 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

13925010801 Hyoscyamine TR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

24486060210 HyoMax SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

43199001401 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

51285093305 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

51991013001 Hyoscyamine TR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

Page 285: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868393900 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

54868393901 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

54868527700 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

55887052821 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

55887053021 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

55887053030 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

58016003230 Hyoscyamine TR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

58177023704 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

60258080301 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

62175010801 Hyoscyamine Sulfate SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

64543011201 Symax SR hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

68220011510 Levbid hyoscyamine 0.375 mg oral tablet, extended release oral belladonna alkaloids d00985

00682033401 Urimar-T hyoscyamine/methenam/m-blue/phenyl salicyl 0.03 mg-40.8 mg-5.4 mg-18.1 mg oral tablet

oral belladonna alkaloids d03618

60258051501 MHP-A hyoscyamine/methenam/m-blue/phenyl salicyl 0.03 mg-40.8 mg-5.4 mg-18.1 mg oral tablet

oral belladonna alkaloids d03618

61451218301 Urised hyoscyamine/methenam/m-blue/phenyl salicyl 0.03 mg-40.8 mg-5.4 mg-18.1 mg oral tablet

oral belladonna alkaloids d03618

00076011101 Uribel hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-118 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

00076090301 Ustell hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

45985064601 Uta hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

54868500300 Uta hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

54868500301 Uta hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

Page 286: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60258051901 UTICAP hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

68032029310 Phosenamine hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-120 mg-10 mg-36 mg oral capsule

oral belladonna alkaloids d03618

66663021901 Urelle hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81 mg-10.8 mg-32.4 mg oral tablet

oral belladonna alkaloids d03618

68032028190 Darpaz hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81 mg-10.8 mg-32.4 mg oral tablet

oral belladonna alkaloids d03618

00076090101 Hyophen hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

00076090201 Phosphasal hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

00485005101 Urogesic Blue (obsolete) hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

12830030101 Uro Blue hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

12830030501 Uro Blue hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

15456080503 Prosed/DS hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

51862017501 UR N-C hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

55566810101 Prosed/DS hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

60258051401 Utrona hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

60258051801 Utrona-C hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

63717051301 Utira-C hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

68032028710 Darcalma hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

Page 287: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68032033410 Atropine/Benz/Hyos/Methen/Meth Blue/Phen Sal

hyoscyamine/methenam/m-blue/phenyl salicyl 0.12 mg-81.6 mg-10.8 mg-36.2 mg oral tablet

oral belladonna alkaloids d03618

00087054301 Vasodilan isoxsuprine 10 mg oral tablet oral vasodilators d00693

00781184001 Isoxsuprine Hydrochloride isoxsuprine 10 mg oral tablet oral vasodilators d00693

00087054401 Vasodilan isoxsuprine 20 mg oral tablet oral vasodilators d00693

00781184201 Isoxsuprine Hydrochloride isoxsuprine 20 mg oral tablet oral vasodilators d00693

54868146400 Isoxsuprine Hydrochloride isoxsuprine 20 mg oral tablet oral vasodilators d00693

59743008610 Isoxsuprine Hydrochloride isoxsuprine 20 mg oral tablet oral vasodilators d00693

00093031401 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157104 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157106 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157110 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157112 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157115 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157120 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00247157130 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00378113401 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

16590013810 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

16590013820 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

16590013830 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

16590013840 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

18837028830 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

21695043230 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

23490579101 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

23490579102 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

Page 288: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490579103 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

23490579104 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

33358019930 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

49999013010 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

49999013015 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

49999013020 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

49999013021 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

49999013030 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

50111060801 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

51655088952 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

51655088954 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051208 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051209 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051210 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051212 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051214 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051215 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051220 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051230 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051240 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

52959051260 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54569449400 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54569449401 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54569449402 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54569449403 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

Page 289: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569449404 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54868417100 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

54868417101 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55045253003 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55045253004 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55045253005 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55289032810 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55289032812 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55289032815 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55289032820 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55289032830 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55887088015 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55887088020 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55887088030 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

55887088060 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

57866738201 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

57866738203 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024700 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024702 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024703 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024710 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024712 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024715 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024720 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024721 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

Page 290: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016024730 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024740 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024760 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024773 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024789 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58016024790 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

58177030104 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

60760031420 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63629297401 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63629297402 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63629297403 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047201 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047203 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047208 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047210 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047212 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047215 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047216 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047220 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047221 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047230 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

63874047250 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

66267041820 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

66336044608 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

66336044610 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

Page 291: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336044620 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

68115019215 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

68115019220 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

68115019230 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

68387044020 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

68387044030 Ketorolac Tromethamine ketorolac 10 mg oral tablet oral analgesics d00273

00338269175 Meperidine Hydrochloride meperidine 10 mg/mL injectable solution injectable narcotics d00017

00409603004 Meperidine Hydrochloride meperidine 10 mg/mL injectable solution injectable narcotics d00017

24200035980 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553017041 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553017248 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553017348 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553061175 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553067644 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

61553084148 Meperidine Hydrochloride meperidine 10 mg/mL-NaCl 0.9% intravenous solution intravenous narcotics d00017

00024033704 Demerol HCl meperidine 100 mg oral tablet oral narcotics d00017

00054459625 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00054859611 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00406711501 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00555038202 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00591072701 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

Page 292: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603441621 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00904197860 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

49999083801 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

49999083830 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

52152015702 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

52152015704 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

57664047108 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

60429053501 Meperidine Hydrochloride meperidine 100 mg oral tablet oral narcotics d00017

00074120120 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

00074125601 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

00182913165 Meperidine Hydrochloride meperidine 100 mg/mL injectable solution injectable narcotics d00017

00409118069 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

00409120120 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

00409125601 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

10019015868 Meperidine Hydrochloride meperidine 100 mg/mL injectable solution injectable narcotics d00017

10019016201 Meperidine Hydrochloride meperidine 100 mg/mL injectable solution injectable narcotics d00017

10019016244 Meperidine Hydrochloride meperidine 100 mg/mL injectable solution injectable narcotics d00017

54868361000 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

54868475100 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

54868475101 Demerol HCl meperidine 100 mg/mL injectable solution injectable narcotics d00017

00409117630 Demerol HCl meperidine 25 mg/mL injectable solution injectable narcotics d00017

00641113025 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

00641605225 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

10019015144 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

10019015147 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

Page 293: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

10019015901 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

10019015944 Meperidine Hydrochloride meperidine 25 mg/mL injectable solution injectable narcotics d00017

00024033502 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

00024033504 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

00054459525 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00054859511 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00406711301 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00555038102 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00591072601 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00603441521 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00904197760 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

23490930003 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

23490930006 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

23490930009 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

49999083730 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

51224015550 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

52152015802 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

52152015804 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

54868107100 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

54868107101 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

54868107102 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

54868107103 Demerol HCl meperidine 50 mg oral tablet oral narcotics d00017

54868123301 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

54868123302 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

54868123303 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

Page 294: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887005130 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

57664046708 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

60429053401 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

68071076030 Meperidine Hydrochloride meperidine 50 mg oral tablet oral narcotics d00017

00054354563 Meperidine Hydrochloride meperidine 50 mg/5 mL oral syrup oral narcotics d00017

00074118130 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00074120301 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00074125301 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00074125401 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00074125502 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409117830 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409118130 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409120301 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409125301 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409125401 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409125502 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00641114025 Meperidine Hydrochloride meperidine 50 mg/mL injectable solution injectable narcotics d00017

10019016001 Meperidine Hydrochloride meperidine 50 mg/mL injectable solution injectable narcotics d00017

10019016044 Meperidine Hydrochloride meperidine 50 mg/mL injectable solution injectable narcotics d00017

54868061600 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

54868323001 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

54868580800 Demerol HCl meperidine 50 mg/mL injectable solution injectable narcotics d00017

00409117930 Demerol HCl meperidine 75 mg/mL injectable solution injectable narcotics d00017

10019016101 Meperidine Hydrochloride meperidine 75 mg/mL injectable solution injectable narcotics d00017

10019016144 Meperidine Hydrochloride meperidine 75 mg/mL injectable solution injectable narcotics d00017

Page 295: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603442421 Meprozine meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

23490777501 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

23490777502 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

23490777503 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

23490777504 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

52152019002 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

54868515100 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

54868515101 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

54868515102 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

54868515103 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

54868515104 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

55887006404 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

58177002704 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

66336041630 Meperidine HCl-Promethazine HCl meperidine-promethazine 50 mg-25 mg oral capsule oral narcotics d03433

51991041802 Mephobarbital mephobarbital 100 mg oral tablet oral barbiturates d00919

67386080302 Mebaral mephobarbital 100 mg oral tablet oral barbiturates d00919

51991041602 Mephobarbital mephobarbital 32 mg oral tablet oral barbiturates d00919

54868407200 Mebaral mephobarbital 32 mg oral tablet oral barbiturates d00919

67386080102 Mebaral mephobarbital 32 mg oral tablet oral barbiturates d00919

51991041702 Mephobarbital mephobarbital 50 mg oral tablet oral barbiturates d00919

67386080202 Mebaral mephobarbital 50 mg oral tablet oral barbiturates d00919

00591523901 Meprobamate meprobamate 200 mg oral tablet oral antianxiety d00288

00591523910 Meprobamate meprobamate 200 mg oral tablet oral antianxiety d00288

23155012801 Meprobamate meprobamate 200 mg oral tablet oral antianxiety d00288

55111064001 Meprobamate meprobamate 200 mg oral tablet oral antianxiety d00288

Page 296: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247103128 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

00591523801 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

00591523810 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

23155012901 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

54569093502 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

55111064101 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

55289098330 Meprobamate meprobamate 400 mg oral tablet oral antianxiety d00288

00185044801 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00185044810 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00247204810 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00247204820 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00247204821 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00247204830 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00247204840 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

10544034530 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

16590020730 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

16590020740 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

16590020760 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

16590020771 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 297: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590020772 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

16590020790 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

18837014430 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

18837014460 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

18837014490 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

18837014494 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

18837014498 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

21695012315 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

21695012330 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

21695012360 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

33358032501 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

33358032530 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

33358032545 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

33358032560 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

33358032590 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

43063023910 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 298: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

43063023915 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

43063023920 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

43063023921 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

43063023930 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

43063023940 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036301 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036315 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036316 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036318 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036320 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036330 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036360 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

49999036390 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

51655024053 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959059615 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959059620 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 299: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959059630 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959059640 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959059660 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959059690 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070900 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070902 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070914 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070915 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070918 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070920 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070921 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070928 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070930 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070940 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070942 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070945 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 300: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959070950 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070956 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070960 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

52959070990 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54569547700 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54569547701 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54569547702 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54569547705 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54569547706 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473300 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473301 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473302 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473303 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473304 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473305 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

54868473306 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 301: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868473307 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297200 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297204 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297205 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297206 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297207 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55045297208 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55289073610 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55289073615 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55289073620 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55289073621 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55289073630 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063107 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063112 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063115 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063120 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 302: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887063130 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063140 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

55887063160 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092700 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092702 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092703 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092730 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092760 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092773 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092777 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092789 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58016092790 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58864084620 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

58864084640 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

60760013606 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

60760013630 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 303: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

60793013601 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

60793013605 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63629276801 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63629276802 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63629276803 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63629276804 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110101 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110102 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110103 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110104 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110105 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110106 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110108 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

63874110109 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

64720032110 Metaxalone metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061108 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

Page 304: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267061115 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061120 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061121 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061130 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061140 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

66267061142 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031900 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031908 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031915 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031920 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031930 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031960 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031990 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

68115031999 Skelaxin metaxalone 800 mg oral tablet oral skeletal muscle relaxants d00964

00378811501 Methamphetamine Hydrochloride methamphetamine 5 mg oral tablet oral amphetamines d00805

54868513600 Methamphetamine Hydrochloride methamphetamine 5 mg oral tablet oral amphetamines d00805

67386010201 Desoxyn methamphetamine 5 mg oral tablet oral amphetamines d00805

Page 305: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00031742963 Robaxin methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00091742963 Robaxin methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00115390001 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00115390002 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00115390003 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00143129001 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00143129005 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00182057201 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00182057205 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018003 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018004 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018006 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018010 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018012 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018014 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018015 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 306: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247018020 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018021 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018024 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018028 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018040 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00247018060 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00440174040 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00440774020 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00527130201 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00527130205 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00591538101 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00591538105 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00603448521 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00603448528 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00615063701 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00615063705 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 307: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00781176001 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00904236440 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00904236460 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

16590014730 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

16590014745 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

16590014760 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

16590014772 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

16590014790 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

18837008730 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

18837008760 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

21695007820 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

21695007830 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

21695007860 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

21695007890 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

23490588201 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

23490588202 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 308: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490588203 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

23490588204 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

23490588205 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

23490588206 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

31722053301 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

31722053305 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

33358023914 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

33358023920 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

33358023930 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

33358023960 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

33358023990 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

49999004801 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

49999004820 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

49999004830 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

49999004840 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

49999004860 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 309: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999004890 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

51655057624 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

51655057652 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016700 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016703 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016710 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016712 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016715 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016720 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016721 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016724 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016730 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016740 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016760 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

52959016790 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54348010920 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 310: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569085200 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085201 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085203 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085204 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085205 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085206 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085207 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569085209 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569461400 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54569461402 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058601 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058602 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058603 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058605 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058606 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

54868058607 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 311: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868060400 Robaxin methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153100 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153101 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153102 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153103 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153104 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153106 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153108 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045153109 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55045371804 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067001 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067010 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067012 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067014 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067020 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067024 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 312: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289067028 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067030 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067040 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067060 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067090 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55289067093 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090714 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090720 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090728 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090730 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090760 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

55887090782 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

57866402601 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

57866402602 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025700 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025702 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 313: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016025703 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025712 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025714 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025715 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025720 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025724 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025730 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025740 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025750 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025773 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025784 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025789 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58016025799 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

58864004356 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

60760029030 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073930 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 314: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392073931 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073932 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073939 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073945 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073951 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073954 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073960 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073990 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

61392073991 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

62584078001 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

62584078011 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63629162201 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63629162202 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63629162203 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63629162204 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63739016610 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 315: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63739016615 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037101 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037103 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037104 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037112 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037114 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037115 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037120 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037124 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037130 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037140 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037150 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037160 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037173 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

63874037184 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66267014520 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

Page 316: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267014530 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66267014540 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66267014560 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66267014590 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66336008020 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66336008030 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

66336008040 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023400 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023420 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023430 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023440 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023460 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68115023490 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

68387034260 Methocarbamol methocarbamol 500 mg oral tablet oral skeletal muscle relaxants d00965

00031744963 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00031744970 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 317: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00091744963 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00091744970 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00115390201 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00115390202 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00115390203 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00143129201 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00143129205 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001300 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001303 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001306 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001307 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001308 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001309 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001312 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001315 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001318 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 318: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247001320 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001321 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001325 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001328 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001330 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001340 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001360 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247001398 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247105507 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247105528 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247105540 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00247105560 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00440774120 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00527115201 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00527115205 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00591538201 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 319: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00591538205 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00603448621 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00603448628 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00603448632 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00615063801 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00615063805 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00781175001 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00904236540 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00904236560 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

12280014200 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

16590014830 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

16590014845 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

16590014860 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

16590014872 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

16590014890 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

18837008830 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 320: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

18837008860 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

18837008890 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

18837008894 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

18837008898 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

21695007920 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

21695007960 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

21695007990 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588301 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588302 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588303 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588304 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588305 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

23490588306 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

31722053401 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

31722053405 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

33358024001 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 321: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

33358024020 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

33358024030 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

33358024040 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

33358024060 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

33358024090 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

43353043660 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006501 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006512 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006520 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006530 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006540 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006560 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

49999006590 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

51655014150 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

51655014152 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52244044910 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 322: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959009900 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009903 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009910 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009915 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009920 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009921 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009928 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009930 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009940 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009945 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009950 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009960 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

52959009990 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084300 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084301 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084302 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 323: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569084303 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084304 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084306 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569084307 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569404804 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54569596600 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110300 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110303 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110306 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110307 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110308 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

54868110309 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138600 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138601 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138602 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138603 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 324: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045138604 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138605 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138606 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138607 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138608 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045138609 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045322901 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55045322908 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289001720 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289001740 Robaxin-750 methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016401 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016410 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016415 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016420 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016428 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016430 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 325: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289016440 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016460 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016490 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55289016493 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086014 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086020 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086028 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086030 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086040 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086050 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086082 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

55887086090 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

57866402701 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

57866402702 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

57866402704 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025800 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 326: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016025802 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025803 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025808 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025810 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025812 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025814 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025815 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025820 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025821 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025824 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025828 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025830 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025840 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025842 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025846 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025850 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 327: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016025856 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025860 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025873 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025880 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025889 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025890 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025892 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58016025899 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58864065220 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

58864065230 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

60760034740 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074030 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074031 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074032 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074039 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074045 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 328: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392074051 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074054 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074060 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074090 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

61392074091 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

62584078101 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

62584078111 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162301 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162302 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162303 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162304 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162305 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162306 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63629162307 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63739016710 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63739016715 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 329: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874037201 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037203 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037204 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037208 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037210 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037212 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037214 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037215 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037220 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037221 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037224 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037228 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037230 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037240 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037242 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037250 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 330: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874037256 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037260 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

63874037290 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66267014612 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66267014620 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66267014630 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66267014640 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66267014660 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66336006320 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66336006328 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66336006330 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66336006340 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

66336006360 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68115023515 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68115023520 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68115023530 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

Page 331: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68115023560 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68115023590 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68115023599 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68387034030 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68387034045 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68387034060 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

68387034090 Methocarbamol methocarbamol 750 mg oral tablet oral skeletal muscle relaxants d00965

00078044005 Ritalin methylphenidate 10 mg oral tablet oral amphetamines d00900

00083000330 Ritalin methylphenidate 10 mg oral tablet oral amphetamines d00900

00182106601 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00182106610 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00406112201 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

00406112210 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

00406114401 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00406114410 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00591588301 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00591588310 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00781574901 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00781884101 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00904276960 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

00904276980 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

Page 332: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999084330 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

53014053007 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

53014053012 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868073300 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868073301 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868073302 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868073303 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868073304 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

54868507300 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

54868507301 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

54868507302 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

54868507303 Methylin methylphenidate 10 mg oral tablet oral amphetamines d00900

55289082930 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

55289082960 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

55289082990 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

60429053701 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

60429053710 Methylphenidate Hydrochloride methylphenidate 10 mg oral tablet oral amphetamines d00900

59630076210 Methylin methylphenidate 10 mg oral tablet, chewable oral amphetamines d00900

68188013701 Methylin methylphenidate 10 mg oral tablet, chewable oral amphetamines d00900

00078042405 Ritalin LA methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

53014057407 Metadate CD methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

53014057907 Metadate CD methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868536700 Ritalin LA methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

Page 333: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868536701 Ritalin LA methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868539700 Metadate CD methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868539701 Metadate CD methylphenidate 10 mg/24 hr oral capsule, extended release oral amphetamines d00900

51991071350 Methylphenidate Hydrochloride methylphenidate 10 mg/5 mL oral solution oral amphetamines d00900

59630075550 Methylin methylphenidate 10 mg/5 mL oral solution oral amphetamines d00900

68188088250 Methylin methylphenidate 10 mg/5 mL oral solution oral amphetamines d00900

00406142301 Methylin ER methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

00406144501 Methylphenidate Hydrochloride SR methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

53014059307 Metadate ER methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868583200 Methylphenidate Hydrochloride SR methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868583201 Methylphenidate Hydrochloride SR methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

60429053901 Methylphenidate Hydrochloride SR methylphenidate 10 mg/8 hr oral tablet, extended release oral amphetamines d00900

54092055210 Daytrana methylphenidate 10 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

54092055230 Daytrana methylphenidate 10 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

68968555203 Daytrana methylphenidate 10 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

68968555230 Daytrana methylphenidate 10 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

54092055310 Daytrana methylphenidate 15 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

54092055330 Daytrana methylphenidate 15 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

68968555303 Daytrana methylphenidate 15 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

00591271501 Methylphenidate Hydrochloride ER methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

Page 334: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

17314585002 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015130 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015190 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

50458058501 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868448900 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868448901 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868448902 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868448903 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289083530 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289083590 Concerta methylphenidate 18 mg/24 hr oral tablet, extended release oral amphetamines d00900

59630076010 Methylin methylphenidate 2.5 mg oral tablet, chewable oral amphetamines d00900

68188013201 Methylin methylphenidate 2.5 mg oral tablet, chewable oral amphetamines d00900

00078044105 Ritalin methylphenidate 20 mg oral tablet oral amphetamines d00900

00083003430 Ritalin methylphenidate 20 mg oral tablet oral amphetamines d00900

00182117401 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00247189600 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00247189630 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00247189660 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00247189677 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00247189690 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00406112401 Methylin methylphenidate 20 mg oral tablet oral amphetamines d00900

00406112410 Methylin methylphenidate 20 mg oral tablet oral amphetamines d00900

00406114601 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00406114610 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00591588401 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

Page 335: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00591588410 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00781575301 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00781884201 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00904277060 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00904277080 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

49999084430 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

53014053207 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

53014053212 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

54868276200 Ritalin methylphenidate 20 mg oral tablet oral amphetamines d00900

54868297400 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

54868297401 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

54868297402 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

54868297403 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

60429053801 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

60429053810 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

63629316601 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

63629316602 Methylphenidate Hydrochloride methylphenidate 20 mg oral tablet oral amphetamines d00900

00078037005 Ritalin LA methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

35356016530 Ritalin LA methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

35356016590 Ritalin LA methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

53014057507 Metadate CD methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

53014058007 Metadate CD methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

Page 336: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868471800 Metadate CD methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868471801 Metadate CD methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868572000 Ritalin LA methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868572001 Ritalin LA methylphenidate 20 mg/24 hr oral capsule, extended release oral amphetamines d00900

00078044205 Ritalin-SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

00182914701 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

00406145101 Methylin ER methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

00406147301 Methylphenidate Hydrochloride ER methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

00781575401 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

00904277360 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

23490795503 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

53014059407 Metadate ER methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868241800 Ritalin-SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868241801 Ritalin-SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868241802 Ritalin-SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345400 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345401 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345402 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345403 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345404 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345405 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54868345406 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

60429054001 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

Page 337: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63629306501 Methylphenidate Hydrochloride SR methylphenidate 20 mg/8 hr oral tablet, extended release oral amphetamines d00900

54092055410 Daytrana methylphenidate 20 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

54092055430 Daytrana methylphenidate 20 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

68968555403 Daytrana methylphenidate 20 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

00591271601 Methylphenidate Hydrochloride ER methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

17314585302 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015230 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015290 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

50458058801 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868495700 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868495701 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289097590 Concerta methylphenidate 27 mg/24 hr oral tablet, extended release oral amphetamines d00900

00078037105 Ritalin LA methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

53014057607 Metadate CD methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

53014058107 Metadate CD methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

54868066800 Metadate CD methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

54868066801 Metadate CD methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

54868554400 Ritalin LA methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

54868554401 Ritalin LA methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

Page 338: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868554402 Ritalin LA methylphenidate 30 mg/24 hours oral capsule, extended release oral amphetamines d00900

54092055510 Daytrana methylphenidate 30 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

54092055530 Daytrana methylphenidate 30 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

68968555503 Daytrana methylphenidate 30 mg/9 hr transdermal film, extended release transdermal amphetamines d00900

00591271701 Methylphenidate Hydrochloride ER methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

17314585102 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015330 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015390 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

50458058601 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868475900 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868475901 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868475902 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868475903 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289085930 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289085990 Concerta methylphenidate 36 mg/24 hr oral tablet, extended release oral amphetamines d00900

00078037205 Ritalin LA methylphenidate 40 mg/24 hr oral capsule, extended release oral amphetamines d00900

53014058207 Metadate CD methylphenidate 40 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868540700 Ritalin LA methylphenidate 40 mg/24 hr oral capsule, extended release oral amphetamines d00900

54868540701 Ritalin LA methylphenidate 40 mg/24 hr oral capsule, extended release oral amphetamines d00900

00078043905 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

00083000730 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

Page 339: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00182117301 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00182117310 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00406112101 Methylin methylphenidate 5 mg oral tablet oral amphetamines d00900

00406112110 Methylin methylphenidate 5 mg oral tablet oral amphetamines d00900

00406114201 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00406114210 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00591588201 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00591588210 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00781574801 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00781884001 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00904276860 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

00904276880 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

23490795403 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

49999084230 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

53014053107 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

53014053112 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170400 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170401 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170402 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170403 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170404 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170405 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170600 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170601 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

54868170602 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

Page 340: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868170603 Ritalin methylphenidate 5 mg oral tablet oral amphetamines d00900

55289081930 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

55289081960 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

55289081990 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

60429053601 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

60429053610 Methylphenidate Hydrochloride methylphenidate 5 mg oral tablet oral amphetamines d00900

59630076110 Methylin methylphenidate 5 mg oral tablet, chewable oral amphetamines d00900

68188013501 Methylin methylphenidate 5 mg oral tablet, chewable oral amphetamines d00900

51991071250 Methylphenidate Hydrochloride methylphenidate 5 mg/5 mL oral solution oral amphetamines d00900

59630075050 Methylin methylphenidate 5 mg/5 mL oral solution oral amphetamines d00900

68188088150 Methylin methylphenidate 5 mg/5 mL oral solution oral amphetamines d00900

53014058307 Metadate CD methylphenidate 50 mg/24 hours oral capsule, extended release oral amphetamines d00900

00591271801 Methylphenidate Hydrochloride ER methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

17314585202 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015430 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

35356015490 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

50458058701 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868478900 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

54868478901 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289085430 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

55289085490 Concerta methylphenidate 54 mg/24 hr oral tablet, extended release oral amphetamines d00900

53014058407 Metadate CD methylphenidate 60 mg/24 hours oral capsule, extended release oral amphetamines d00900

00187090101 Testred methylTESTOSTERone 10 mg oral capsule oral others d00295

00187090201 Android methylTESTOSTERone 10 mg oral capsule oral others d00295

Page 341: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016096700 Testred methylTESTOSTERone 10 mg oral capsule oral others d00295

58016096730 Testred methylTESTOSTERone 10 mg oral capsule oral others d00295

58016096760 Testred methylTESTOSTERone 10 mg oral capsule oral others d00295

58016096790 Testred methylTESTOSTERone 10 mg oral capsule oral others d00295

00115703701 Methitest methylTESTOSTERone 10 mg oral tablet oral others d00295

00904080860 MethylTESTOSTERone methylTESTOSTERone 10 mg oral tablet oral others d00295

54569084100 MethylTESTOSTERone methylTESTOSTERone 10 mg oral tablet oral others d00295

00247187200 MethylTESTOSTERone methylTESTOSTERone 25 mg oral tablet oral others d00295

00904080960 MethylTESTOSTERone methylTESTOSTERone 25 mg oral tablet oral others d00295

00904080980 MethylTESTOSTERone methylTESTOSTERone 25 mg oral tablet oral others d00295

00024195104 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00247103712 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00247103720 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00247103790 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00406311801 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00591039501 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

21695036428 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

21695036460 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

21695036472 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

23490607301 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

23490607303 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

23490607308 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

35356017630 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

35356032930 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

43063014220 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

Page 342: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

43386068001 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52152021102 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52152021104 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959034010 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959034012 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959034024 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959034030 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959034040 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054502 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054510 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054512 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054515 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054520 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054524 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054530 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054535 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054540 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054550 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054560 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

52959054590 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

54569577201 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

54868146501 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

54868478800 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

54868478801 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045203803 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

Page 343: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045309900 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309901 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309903 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309904 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309905 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309907 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309908 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55045309909 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55289018420 Talwin NX naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017101 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017130 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017160 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017183 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017184 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017186 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

55887017190 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039200 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039210 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039212 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039220 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039230 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039240 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

58016039260 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

60429057001 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63629320601 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

Page 344: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874022001 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022003 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022004 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022010 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022012 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022015 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022020 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022030 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022035 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022040 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022060 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

63874022090 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

66267048730 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

66267048740 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

68115046230 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

68115046260 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

68115060500 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

68387053112 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

68387053160 Naloxone HCl-Pentazocine HCl naloxone-pentazocine 0.5 mg-50 mg oral tablet oral narcotics d03676

00069260066 Procardia NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00182154701 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00182154796 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00228249710 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 345: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247020600 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020601 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020602 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020603 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020605 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020606 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020609 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020610 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020612 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020614 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020615 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020620 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020630 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020640 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020660 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00247020690 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 346: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00339571712 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

33358026100 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

33358026120 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

33358026130 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

33358026190 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

43386044024 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

49999016190 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027300 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027301 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027308 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027310 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027320 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027330 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027340 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027350 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

52959027360 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 347: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959027380 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312100 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312101 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312102 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312103 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312104 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54569312105 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54868132600 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54868132602 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54868132604 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54868132605 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

54868132606 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55289090708 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55289090730 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55289090779 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55289090797 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 348: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887066801 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55887066810 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55887066813 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55887066815 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

55887066830 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062200 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062208 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062212 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062215 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062220 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062230 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062250 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062260 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58016062290 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

58864079620 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

61392035615 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 349: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392035645 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

61392035656 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63629155801 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63629155802 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63629155803 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63629155804 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033801 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033803 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033808 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033810 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033812 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033815 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033820 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033830 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033850 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

63874033860 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

Page 350: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874033890 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

68115025530 Nifedipine NIFEdipine 10 mg oral capsule oral calcium channel blockers d00051

00182154801 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00182154896 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00228253010 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00247126900 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00247126999 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00339571812 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

00615035913 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

52959048830 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

54569312202 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

54868152100 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

54868152102 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58016062000 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58016062012 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58016062015 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

Page 351: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016062020 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58016062030 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58016062090 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

58864079730 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035334 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035336 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035345 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035354 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035356 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

61392035391 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

68115047260 Nifedipine NIFEdipine 20 mg oral capsule oral calcium channel blockers d00051

59630045008 Furadantin nitrofurantoin 25 mg/5 mL oral suspension oral others d00112

59630045016 Furadantin nitrofurantoin 25 mg/5 mL oral suspension oral others d00112

65162068988 Nitrofurantoin nitrofurantoin 25 mg/5 mL oral suspension oral others d00112

66993047173 Nitrofurantoin nitrofurantoin 25 mg/5 mL oral suspension oral others d00112

00093213101 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00093213110 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00093213119 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00093213193 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

Page 352: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00149000905 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025800 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025804 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025806 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025810 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025814 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025820 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025828 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025830 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025840 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025847 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247025890 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247069610 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247069614 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247069620 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247069628 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00247069630 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00378170001 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00378170005 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00440786614 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00591325401 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00904772240 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00904772260 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

21695030014 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

21695030020 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

Page 353: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490599400 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

23490599401 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

23490599402 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

23490599403 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026514 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026520 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026714 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026728 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026730 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

33358026740 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

43063017302 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

47781030801 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

49999021014 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

49999021020 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

49999021028 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

51079058501 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

51079058520 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52427028801 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52555078701 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040500 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040508 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040510 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040514 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040515 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040516 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

Page 354: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959040520 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040521 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040528 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040530 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959040540 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959078310 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

52959078314 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54569196900 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54569196901 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54569196902 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54569557601 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047300 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047301 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047302 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047303 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047304 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047305 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047306 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

54868047307 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020312 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020314 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020320 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020328 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020330 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289020340 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

Page 355: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289091412 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289091414 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289091415 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289091428 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289091430 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

55289091440 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

57866659004 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58016003400 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58016003430 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58016003460 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58016003490 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58864037114 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58864037120 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58864037130 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

58864065114 Macrodantin nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016830 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016831 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016832 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016839 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016845 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016851 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016854 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016860 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016890 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

61392016891 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

Page 356: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

62584080801 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

62584080811 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

63629145901 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

63629145902 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

63629145903 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

63629174801 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

63629174802 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

66336000814 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

66336000828 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

66336059014 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

66336059020 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

68115025828 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 100 mg oral capsule oral others d00112

00149000705 Macrodantin nitrofurantoin macrocrystals 25 mg oral capsule oral others d00112

52427028601 Macrodantin nitrofurantoin macrocrystals 25 mg oral capsule oral others d00112

00093213001 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00093213010 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00093213019 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00093213093 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00149000805 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013702 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013704 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013708 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013710 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013712 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013714 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

Page 357: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247013720 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013721 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013728 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013730 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247013740 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015910 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015914 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015920 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015921 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015928 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015930 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00247015940 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00378165001 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00378165005 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00591325301 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00615130813 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00904772140 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00904772160 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

47781030701 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

51079058420 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54569018100 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54569018101 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54569018102 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54569018104 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54868010700 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

Page 358: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868010702 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54868010705 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54868010706 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

54868042903 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289017912 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289017928 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289017940 Macrodantin nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018612 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018614 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018620 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018621 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018628 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

55289018640 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014200 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014210 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014214 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014215 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014220 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014224 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014228 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014230 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

58016014240 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016930 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016931 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016932 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

Page 359: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392016939 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016945 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016951 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016954 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016960 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016990 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

61392016991 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

68115025928 Nitrofurantoin Macrocrystals nitrofurantoin macrocrystals 50 mg oral capsule oral others d00112

00149071001 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00185012201 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00185012210 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016402 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016403 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016406 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016410 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016414 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016420 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016421 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247016490 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

Page 360: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247207100 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207102 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207103 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207104 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207106 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207110 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207114 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00247207128 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00378342201 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00591325001 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

16590038014 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

23490684001 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

23490684002 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

23490684003 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

23490684004 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

47781030301 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

Page 361: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999067514 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

51079034801 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

51079034820 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

51655059384 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

52427028501 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

52959040410 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

52959040414 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

52959040420 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

52959078320 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54348085006 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569354400 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569354401 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569354402 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569354403 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569354404 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54569557600 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

Page 362: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868236600 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236601 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236602 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236603 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236604 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236605 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236606 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

54868236607 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55045234105 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55045318205 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289003106 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289003110 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289003114 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289003120 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289020310 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289082206 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

Page 363: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289082214 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55289082220 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55887040706 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55887040710 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55887040714 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55887040720 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

55887040730 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58016088600 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58016088620 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58016088630 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58016088660 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58016088690 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

58864032314 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

63304051801 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

66105045010 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

68084044601 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

Page 364: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68084044611 Nitrofurantoin Monohydrate/Macrocrystals

nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

68115022006 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

68115022014 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

68115022020 Macrobid nitrofurantoin macrocrystals-monohydrate 100 mg oral capsule oral others d00112

00115201101 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00115201102 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00185002201 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00185002210 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036802 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036808 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036810 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036814 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036820 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00247036830 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

16590017720 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

16590017730 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 365: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590017760 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

16590017772 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

16590017790 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

18837011730 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

18837011760 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

18837011790 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

21695009914 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

21695009930 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

21695009960 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

23490603901 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

23490603902 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

23490603903 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

23490603904 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

23490603909 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008810 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008814 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 366: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

33261008820 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008821 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008830 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008860 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33261008890 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33358027420 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33358027430 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

33358027460 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

43386048024 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

49999004614 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

49999004620 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

49999004630 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52152034002 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052710 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052714 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052715 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 367: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959052720 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052730 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052742 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052760 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

52959052890 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54569083800 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54569083801 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54569083802 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54569083803 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54569083806 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410200 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410201 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410202 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410203 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410204 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

54868410205 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 368: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045132500 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132501 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132502 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132503 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132505 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132507 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132508 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55045132509 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55289087714 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55289087720 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55289087730 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55887067015 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55887067020 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55887067030 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55887067060 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

55887067090 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 369: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

57866760102 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

57866760103 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

57866760104 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

57866760105 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

57866760106 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024800 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024807 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024810 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024812 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024814 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024815 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024820 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024821 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024828 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024830 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024840 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 370: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016024842 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024850 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024860 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

58016024890 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

60760081030 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63629156401 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63629156402 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053101 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053104 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053110 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053114 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053120 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053130 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053140 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053160 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

63874053190 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

Page 371: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267015815 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

66267015830 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

66267015860 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

66336055430 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

67544058930 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026410 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026414 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026420 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026430 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026460 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68115026490 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68387057514 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

68387057560 Orphenadrine Citrate orphenadrine 100 mg oral tablet, extended release oral skeletal muscle relaxants d00966

00074194101 Talwin Lactate pentazocine 30 mg/mL injectable solution injectable narcotics d00334

00409192010 Talwin pentazocine 30 mg/mL injectable solution injectable narcotics d00334

00409194101 Talwin pentazocine 30 mg/mL injectable solution injectable narcotics d00334

21695024101 Talwin pentazocine 30 mg/mL injectable solution injectable narcotics d00334

54569190301 Talwin pentazocine 30 mg/mL injectable solution injectable narcotics d00334

Page 372: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868253000 Talwin pentazocine 30 mg/mL injectable solution injectable narcotics d00334

00185525401 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

00185525410 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

00187049801 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

00187049802 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

12280008507 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

12280008514 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

23490608101 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

23490608102 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

23490608103 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

23490608104 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

49999036030 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

52604047001 Adipost phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

52959062828 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

52959062830 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

52959088607 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

52959088630 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569179802 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569179803 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569179806 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569179809 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569219800 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569219801 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54569219802 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

54868307100 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

Page 373: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045174506 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55045174508 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55289030207 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55289030214 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55289030228 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55289030230 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55289053730 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55499108201 Melfiat phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55887022415 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

55887022430 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

63629305101 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

66336056207 Phendimetrazine Tartrate SR phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

66336077907 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

66336077914 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

66336077928 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

68115005090 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

68115005114 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

68115005121 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

68115005130 Bontril Slow Release phendimetrazine 105 mg oral capsule, extended release oral amphetamines d00809

00147013520 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

00185405701 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

00185405710 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

00187049701 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

00187049702 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

00247094807 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

Page 374: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247094814 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

00247094828 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

00247094830 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

00904427080 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

10702007701 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

21695059707 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

21695059760 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608201 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608202 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608203 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608204 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608205 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608206 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608207 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

23490608208 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

33358028715 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

33358028730 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

33358028760 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

35356000328 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

35356000330 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

35356000360 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

35356000390 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

49999000328 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52152032702 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52152032705 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

Page 375: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959028200 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52959028221 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52959028228 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52959028230 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52959028242 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

52959028290 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266800 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266801 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266804 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266805 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266806 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266807 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569266809 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569433600 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519500 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519501 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519502 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519503 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519504 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519505 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519506 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519507 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519508 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569519509 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54569523300 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

Page 376: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569523301 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54868025200 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54868025201 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

54868025203 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55045295408 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55045381708 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289030007 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083407 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083414 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083421 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083428 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083430 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083456 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083460 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083484 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083486 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083488 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083489 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083490 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083493 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083498 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55289083499 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022514 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022515 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022521 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

Page 377: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887022528 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022530 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022542 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022560 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

55887022590 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63629160401 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63629160402 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63629160403 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63629160404 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026901 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026902 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026903 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026907 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026910 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026912 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026914 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026915 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026920 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026921 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026924 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026930 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026940 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

63874026960 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

66336019121 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

66336019128 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

Page 378: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66336019130 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

66336019142 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

66336019156 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

66336019184 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115005007 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115005014 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115005028 Bontril PDM phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115027314 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115027321 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

68115027360 Phendimetrazine Tartrate phendimetrazine 35 mg oral tablet oral amphetamines d00809

00143145801 Phenobarbital PHENobarbital 100 mg oral tablet oral barbiturates d00340

00143145810 Phenobarbital PHENobarbital 100 mg oral tablet oral barbiturates d00340

54868338100 Phenobarbital PHENobarbital 100 mg oral tablet oral barbiturates d00340

64125090301 Phenobarbital PHENobarbital 100 mg oral tablet oral barbiturates d00340

64125090310 Phenobarbital PHENobarbital 100 mg oral tablet oral barbiturates d00340

00143144510 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

00228202696 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

00247082200 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

00247082204 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

52959012400 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

61392038232 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

61392038245 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

61392038251 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

61392038254 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

61392038256 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

Page 379: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392038291 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

63874025420 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

64125091501 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

64125091510 Phenobarbital PHENobarbital 15 mg oral tablet oral barbiturates d00340

00603516521 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

00603516532 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

63739020001 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

63739020003 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

63739020010 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

63739020015 Phenobarbital PHENobarbital 16.2 mg oral tablet oral barbiturates d00340

00121053105 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

00121053107 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

00121053115 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

00121053116 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

00603150858 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

16571033016 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

63874022312 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

63874022348 Phenobarbital PHENobarbital 20 mg/5 mL oral elixir oral barbiturates d00340

00143145010 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00247137004 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00247137009 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00247137030 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00247137060 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00247137090 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00904381680 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

Page 380: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904382780 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

49999039430 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

49999039460 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

49999039490 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

51079009501 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

51079009520 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54569093800 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54569093801 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54569093802 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54868169800 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54868169802 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

54868169803 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

55289033701 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

55887075730 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

58016082606 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

58016082650 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

61392039145 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

61392039154 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

61392039156 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

61392039191 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

64125090101 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

64125090110 Phenobarbital PHENobarbital 30 mg oral tablet oral barbiturates d00340

00603516602 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

00603516616 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

00603516620 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

Page 381: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00603516621 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

00603516622 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

00603516632 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

55289053501 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

63739020101 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

63739020103 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

63739020110 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

63739020115 Phenobarbital PHENobarbital 32.4 mg oral tablet oral barbiturates d00340

00143145510 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

00182059010 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

00615041847 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

49999086700 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

54868121901 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

54868121902 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

54868121903 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

54868121904 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

64125090201 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

64125090210 Phenobarbital PHENobarbital 60 mg oral tablet oral barbiturates d00340

00603516721 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

00603516732 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039230 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039231 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039232 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039239 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039245 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

Page 382: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392039251 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039254 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039260 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039290 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

61392039291 Phenobarbital PHENobarbital 64.8 mg oral tablet oral barbiturates d00340

00603516821 Phenobarbital PHENobarbital 97.2 mg oral tablet oral barbiturates d00340

00603516832 Phenobarbital PHENobarbital 97.2 mg oral tablet oral barbiturates d00340

55887075530 Phenobarbital PHENobarbital 97.2 mg oral tablet oral barbiturates d00340

55887075560 Phenobarbital PHENobarbital 97.2 mg oral tablet oral barbiturates d00340

55887075590 Phenobarbital PHENobarbital 97.2 mg oral tablet oral barbiturates d00340

00093211001 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00185064401 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00185064410 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00247149207 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00247149214 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00247149228 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00247149230 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

10702002601 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

10702002610 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

12280013500 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

21695050900 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

23490609001 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

23490609002 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

23490609003 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

23490609004 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

Page 383: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490609006 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

49999072428 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

49999072430 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

49999072460 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52152017002 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52152017005 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042606 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042607 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042614 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042615 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042624 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042628 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042630 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

52959042660 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54569414300 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54569414302 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54569414304 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54569414305 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54868028300 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

54868028301 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079107 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079114 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079115 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079121 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079128 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

Page 384: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289079130 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55289079160 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55887076207 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55887076214 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55887076215 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55887076230 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

55887076260 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63629295001 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63629295002 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63629295003 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63629295004 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63874027101 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63874027107 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63874027114 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63874027115 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

63874027130 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

66336013307 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

66336013314 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

66336013328 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

66336013330 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

68115027714 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

68115027730 Phentermine Hydrochloride phentermine 15 mg oral capsule oral amphetamines d00806

00147024910 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

00147024920 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

54569266900 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

Page 385: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569266901 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

54569266902 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

54569266903 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

54868105101 Phentermine Hydrochloride phentermine 18.75 mg oral capsule oral amphetamines d00806

00093210901 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147019810 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147019820 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147020110 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147020120 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147020210 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147020220 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00185064701 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00185064710 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00185500001 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00185500010 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062500 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062507 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062514 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062515 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062528 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062530 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247062533 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00247135530 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00527059701 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00527059710 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

Page 386: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00527130801 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00527130810 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00527131001 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00527131010 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00677182301 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00677182310 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00904061460 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00904061480 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00904392160 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00904392180 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

10702002701 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

10702002710 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

10702002801 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

10702002810 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

11808055501 Zantryl phentermine 30 mg oral capsule oral amphetamines d00806

12280023100 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

16590018530 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

16590018560 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

21695051030 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609200 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609201 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609203 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609206 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609207 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490609208 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

Page 387: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490609209 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490724000 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490724001 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490724002 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490724003 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490724004 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490792101 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490792102 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490792103 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

23490792104 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

49999040507 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

49999040528 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

49999040530 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52152016002 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52152016005 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52152017302 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52152017305 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52604001001 T-Diet phentermine 30 mg oral capsule oral amphetamines d00806

52637003010 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52637003510 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52637003610 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959043207 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959043214 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959043230 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959044007 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

Page 388: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

52959044014 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959044015 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959044028 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

52959044030 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

53489043301 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

53489043310 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569039200 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569039202 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569039203 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569039204 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306900 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306902 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306903 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306904 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306905 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54569306906 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54868019200 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54868019201 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54868019204 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54868025300 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

54868025301 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55045126408 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031307 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031314 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031316 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

Page 389: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55289031321 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031328 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031330 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289031360 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289062407 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289062414 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289062428 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289062430 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55289062460 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887071214 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887071230 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887071260 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887089101 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887089114 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887089115 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887089130 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

55887089160 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

58521033305 Oby-Cap phentermine 30 mg oral capsule oral amphetamines d00806

63629294901 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63629294902 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63629294903 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63629294904 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026001 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026002 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026007 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

Page 390: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874026014 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026020 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026030 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

63874026050 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336018507 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336018514 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336018528 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336018530 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336018542 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336076307 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336076314 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336076328 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

66336076330 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

68115027814 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

68115027830 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

68115027900 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

68115027930 Phentermine Hydrochloride phentermine 30 mg oral capsule oral amphetamines d00806

00147023110 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023120 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023410 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023420 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023510 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023520 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147025110 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147025120 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

Page 391: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00147025310 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147025320 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147025410 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147025420 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00247131514 Adipex-P phentermine 37.5 mg oral capsule oral amphetamines d00806

00527174301 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

10702002901 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

10702002910 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

21695051300 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

49999036115 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

49999036130 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

52152016702 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

52152016705 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

54569481601 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

54569481602 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

55887008007 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

55887008030 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

55887008060 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

57844001901 Adipex-P phentermine 37.5 mg oral capsule oral amphetamines d00806

63874027001 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

63874027007 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

63874027030 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

66336042630 Phentermine Hydrochloride phentermine 37.5 mg oral capsule oral amphetamines d00806

00147023210 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00147023220 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

Page 392: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00147024810 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00147024820 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00182020501 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00182020510 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00228301611 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00247131630 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

00247171830 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00527131701 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00527131710 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00527144501 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00527144510 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00603519216 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00603519221 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00603519232 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00677182401 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00677182410 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

10702002501 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

10702002503 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

10702002510 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

16590018630 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

16590018660 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609400 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609401 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609402 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609403 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

Page 393: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

23490609404 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609405 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609406 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

23490609409 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

49999051715 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

49999051730 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

49999051745 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

49999051760 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

51224010150 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

51224010170 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52152015902 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52152015905 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081207 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081210 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081214 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081220 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081230 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081260 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

52959081290 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

53489040601 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

53489040610 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569171800 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

54569171801 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

54569171803 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

54569171804 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

Page 394: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569171805 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320300 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320301 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320302 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320303 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320304 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569320308 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54569522402 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54868008700 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54868008701 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54868008702 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54868008703 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

54868047901 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

55045168908 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289037930 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070107 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070114 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070115 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070121 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070128 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070130 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070145 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070160 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070190 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55289070198 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

Page 395: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887084001 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084007 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084014 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084015 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084020 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084023 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084030 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084045 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084060 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

55887084090 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

57664050418 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

57664050488 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

57844000901 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

58016004300 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

58016004330 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

58016004360 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

58016004390 Adipex-P phentermine 37.5 mg oral tablet oral amphetamines d00806

58016031000 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

58016031030 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

58016031060 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

58016031090 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63629158401 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63629158402 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63629158403 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63629158404 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

Page 396: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63629158405 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028201 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028202 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028210 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028214 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028215 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

63874028230 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66267016607 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66267016630 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66267016645 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66267016660 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66267016690 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034407 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034414 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034428 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034430 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034456 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

66336034484 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

68387069030 Phentermine Hydrochloride phentermine 37.5 mg oral tablet oral amphetamines d00806

00147010220 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

00147013610 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

00147013620 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

00247149307 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

00247149314 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

00247149328 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

Page 397: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247149330 Phentermine Hydrochloride phentermine 8 mg oral tablet oral amphetamines d00806

25332111301 Teramine phentermine 8 mg oral tablet oral amphetamines d00806

52959041830 Ionamin phentermine resin 15 mg oral capsule, extended release oral amphetamines d00806

53014090371 Ionamin phentermine resin 15 mg oral capsule, extended release oral amphetamines d00806

53014090471 Ionamin phentermine resin 30 mg oral capsule, extended release oral amphetamines d00806

00472162804 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

00472162816 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

00603158754 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

00603158758 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

12280011404 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

49999065704 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

52959056804 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

54569573600 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

54868393500 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

54868393501 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

55045169902 Promethazine VC phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

63629186801 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

63629186802 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

Page 398: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63874071112 Promethazine VC Plain phenylephrine-promethazine 5 mg-6.25 mg/5 mL oral syrup oral antihistamines d03317

00115104001 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00247096804 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00247096805 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00247096810 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00247096812 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00247096830 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00378702801 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00378702810 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00406204001 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00603543721 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

10135051401 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

10702000201 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

49999090220 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

52959091430 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

54868512100 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

55289094802 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

57664010788 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

60429014901 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

63629159101 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

63629159102 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

63629159103 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

63629159104 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

65162074510 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

Page 399: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

68084015401 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

68084015411 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

68382004001 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

68382004010 Promethazine Hydrochloride promethazine 12.5 mg oral tablet oral antihistamines d00787

00115104101 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00115104103 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00182822200 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00182822289 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013000 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013002 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013003 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013004 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013005 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013006 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013007 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013008 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013010 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013012 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013014 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013015 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013020 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013024 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013030 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00247013040 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00378702901 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 400: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00378702910 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00406204101 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00406204110 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00440819510 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00591530701 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00591530710 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00603543821 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00603543830 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00603543832 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00781183001 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00781183010 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00904232960 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00904232980 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00904584061 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00904625280 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

10135049501 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

10135049510 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

10544034330 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

10702000301 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

10702000310 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

16590019110 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

16590019115 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

16590019120 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

16590019130 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

16590019160 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 401: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

16590019190 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

18837012710 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

18837012730 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

18837012760 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

18837012790 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

21695045310 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

21695045315 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

21695045320 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

21695045325 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618301 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618302 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618303 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618304 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618306 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618307 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

23490618308 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

33358030208 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

33358030210 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

33358030230 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

33358030260 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

43063004902 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

43063004906 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009005 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009010 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009012 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 402: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49999009015 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009020 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009030 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

49999009060 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

51079089501 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

51079089520 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

51655008453 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053401 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053402 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053410 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053412 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053415 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053420 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053428 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053430 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053445 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053460 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

52959053490 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54569175400 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54569175401 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54569175409 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54569416800 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54868132300 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54868132301 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54868132302 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 403: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868132304 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54868132305 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

54868132306 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159600 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159601 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159602 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159603 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159604 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159605 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159606 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159608 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55045159609 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046402 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046410 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046412 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046415 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046420 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046425 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046430 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55289046479 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093605 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093606 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093608 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093610 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093612 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 404: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55887093615 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093620 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093621 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093625 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093630 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093650 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093660 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

55887093690 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57664010888 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866021501 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437901 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437902 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437904 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437906 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437907 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

57866437908 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042400 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042402 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042403 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042410 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042412 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042415 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042420 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042430 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042450 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 405: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016042460 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042473 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042489 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58016042490 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

58864076110 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015001 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015010 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015012 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015030 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015060 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

60429015090 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174201 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174202 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174203 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174204 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174205 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63629174206 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63739021310 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63739021315 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63874037012 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63874037020 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

63874037030 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

65162052110 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

65162052111 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

66267017730 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

Page 406: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267081304 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

66336008510 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

66336008512 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

66336008530 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68084015501 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68084015511 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68115030200 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68115030204 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68115030220 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68115030230 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68115030290 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68382004101 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68382004110 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68387053630 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

68387053690 Promethazine Hydrochloride promethazine 25 mg oral tablet oral antihistamines d00787

00115104201 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00378703001 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00378703010 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00406204201 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00591531901 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00603543921 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00781183201 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00904233060 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

10135049601 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

10702000401 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

Page 407: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

21695088510 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

54868284400 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

55289053104 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

57664010988 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

60429015101 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

63739038910 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

65162052210 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

68084015601 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

68382004201 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

68382004210 Promethazine Hydrochloride promethazine 50 mg oral tablet oral antihistamines d00787

00182173741 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00247023152 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00247023159 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00436058004 Pentazine promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00436058016 Pentazine promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00436058028 Pentazine promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00536174590 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00603158454 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00603158458 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00904150800 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00904150816 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00904150820 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00904150828 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

23490618701 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

49999026204 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

Page 408: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

50383080116 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

52959013404 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

52959013408 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

52959080404 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

52959080408 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

54569104600 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

54868186700 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

55045164309 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

55887067504 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

57664014631 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

57664014634 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

60432060804 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

60432060816 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

63629187001 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

63629187002 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

63874071212 Promethazine Hydrochloride promethazine 6.25 mg/5 mL oral syrup oral antihistamines d00787

00054472125 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00115430801 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00115430803 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00182185801 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00247136020 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00247136024 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

Page 409: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00904234440 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

00904234460 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

54902007401 Pro-Banthine propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

54902007405 Pro-Banthine propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

54902007452 Pro-Banthine propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

58016001900 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

58016001930 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

58016001960 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

58016001990 Propantheline Bromide propantheline 15 mg oral tablet oral gastrointestinal antispasmodics

d00359

54902007301 Pro-Banthine propantheline 7.5 mg oral tablet oral gastrointestinal antispasmodics

d00359

00002080302 Darvon propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00002080303 Darvon propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00002080333 Darvon propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00093074101 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00143323501 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00143323505 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00143323510 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00182069801 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00182069805 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00247015404 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

Page 410: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247015410 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00247015412 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00247015420 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00247015430 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00247015440 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00378706501 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00603511021 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00603511028 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00603545921 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00603545928 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00904770040 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00904770060 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00904770061 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00904770080 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

12280016000 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

16590019830 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

16590019860 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

16590019872 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

16590019890 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

23155001201 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

23155001205 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

33358030920 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

33358030930 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

33358030960 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

49884012001 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

Page 411: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49884012010 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

49884031401 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

49884031410 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

49999079830 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

49999079860 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

51641032101 PP-Cap propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

51641032105 PP-Cap propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

51641032110 PP-Cap propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

51641032111 PP-Cap propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

52959033420 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

52959033430 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

52959033440 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

52959033445 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

52959033460 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54569022300 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54569022304 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54569022305 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54868146600 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54868146601 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54868146602 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

54868146603 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159900 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159901 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159903 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159904 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

Page 412: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

55045159905 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159906 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159907 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159908 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55045159909 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55289032412 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55289032416 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55289032460 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55887044601 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55887044630 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

55887044640 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

58016021400 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

58016021402 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

58016021430 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

58016021460 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

58016021490 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63629135901 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63629135902 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63629135903 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63874021512 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63874021530 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63874021550 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

63874021560 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

66267017912 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

66267017920 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

Page 413: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

66267017930 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

66479051010 Darvon propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

67544013130 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

67544039630 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

68115030612 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

68115030630 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

68115030660 Propoxyphene Hydrochloride propoxyphene hydrochloride 65 mg oral capsule oral narcotics d00360

00002035302 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

00002035303 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

00002035333 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

54868574400 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

66479051210 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

66591063141 Darvon-N propoxyphene napsylate 100 mg oral tablet oral narcotics d00360

54868556000 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

54868556001 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

55045296202 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

55289023512 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

55887030812 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

55887030818 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

55887030830 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

58016001600 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

58016001630 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

58016001660 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

58016001690 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

60267030100 Scopace scopolamine 0.4 mg oral tablet oral antiemetics d00986

Page 414: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

63717084001 Maldemar scopolamine 0.4 mg oral tablet oral antiemetics d00986

00067434504 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

00247103301 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

00247103303 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

00247103304 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

10019055301 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

10019055302 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

10019055388 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

43063000301 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

54569036700 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

54868280300 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

54868280301 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

55887015004 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

58016479501 Transderm-Scop scopolamine 1.5 mg transdermal film, extended release transdermal antiemetics d00986

42998067901 Seconal Sodium secobarbital 100 mg oral capsule oral barbiturates d00368

63304067901 Seconal Sodium secobarbital 100 mg oral capsule oral barbiturates d00368

63304067980 Seconal Sodium secobarbital 100 mg oral capsule oral barbiturates d00368

00247080007 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

Page 415: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247080014 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

00247080030 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

00378061201 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

00378061210 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

00904161460 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

51079056501 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

51079056520 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

53489014801 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

53489014810 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

57866104201 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

61392046215 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

61392046245 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

61392046256 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

61392046291 Thioridazine Hydrochloride thioridazine 10 mg oral tablet oral antipsychotics, typical d00389

00378061801 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

51079058001 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

51079058020 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

53489050001 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

54868182800 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

54868182802 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046530 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046531 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046532 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046539 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046545 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

Page 416: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

61392046551 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046554 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046560 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

61392046590 Thioridazine Hydrochloride thioridazine 100 mg oral tablet oral antipsychotics, typical d00389

00781167401 Thioridazine Hydrochloride thioridazine 200 mg oral tablet oral antipsychotics, typical d00389

00247080107 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

00247080114 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

00247080130 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

00378061401 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

00378061410 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

51079056601 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

51079056620 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

53489014901 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

53489014910 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

54868006700 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

54868006704 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

54868006705 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

61392046345 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

61392046354 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

61392046391 Thioridazine Hydrochloride thioridazine 25 mg oral tablet oral antipsychotics, typical d00389

00247080207 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

00247080214 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

00247080230 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

00378061601 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

00378061610 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

Page 417: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

51079056701 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

51079056720 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

53489015001 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

53489015010 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

54868183200 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

54868183202 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

54868183203 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046430 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046431 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046432 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046439 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046445 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046451 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046454 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046460 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046490 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

61392046491 Thioridazine Hydrochloride thioridazine 50 mg oral tablet oral antipsychotics, typical d00389

00115482601 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00115482603 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00182049410 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00456046100 Armour Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00456046101 Armour Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00456046163 Armour Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00603605421 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00603605432 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

Page 418: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49483002301 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

49483002310 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

54569091900 Armour Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

54569318002 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

54569562300 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

54569858500 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

55289026290 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

55887075930 Thyroid thyroid desiccated 120 mg oral tablet oral others d00655

00904076260 Thyroid thyroid desiccated 130 mg oral tablet oral others d00655

64727330801 Nature-Throid thyroid desiccated 130 mg oral tablet oral others d00655

64727330802 Nature-Throid thyroid desiccated 130 mg oral tablet oral others d00655

64727708001 Westhroid thyroid desiccated 130 mg oral tablet oral others d00655

64727708002 Westhroid thyroid desiccated 130 mg oral tablet oral others d00655

00456045701 Armour Thyroid thyroid desiccated 15 mg oral tablet oral others d00655

00603605021 Thyroid thyroid desiccated 15 mg oral tablet oral others d00655

49999028960 Armour Thyroid thyroid desiccated 15 mg oral tablet oral others d00655

52959014300 Armour Thyroid thyroid desiccated 15 mg oral tablet oral others d00655

64727329801 Nature-Throid thyroid desiccated 16.25 mg oral tablet oral others d00655

64727329802 Nature-Throid thyroid desiccated 16.25 mg oral tablet oral others d00655

00456046200 Armour Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

00456046201 Armour Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

00603605521 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

00603605532 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

00904076360 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

49483003801 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

Page 419: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

49483003810 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

49999028200 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

49999028260 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

54569092000 Armour Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

54569318101 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

54868008300 Thyroid thyroid desiccated 180 mg oral tablet oral others d00655

64727331201 Nature-Throid thyroid desiccated 195 mg oral tablet oral others d00655

64727331202 Nature-Throid thyroid desiccated 195 mg oral tablet oral others d00655

00456046301 Armour Thyroid thyroid desiccated 240 mg oral tablet oral others d00655

00456045800 Armour Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00456045801 Armour Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00456045811 Armour Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00456045863 Armour Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00603605121 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00603605132 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00904786560 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00904786580 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

12280013000 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

12280020400 Armour Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

23490637401 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

42192032901 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

49483002101 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

49483002110 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

49999028830 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

49999028860 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

Page 420: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54569091700 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

54569091701 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

54569492900 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

54868079400 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

54868079401 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

55045377403 Thyroid thyroid desiccated 30 mg oral tablet oral others d00655

00456046401 Armour Thyroid thyroid desiccated 300 mg oral tablet oral others d00655

64727329901 Nature-Throid thyroid desiccated 32.5 mg oral tablet oral others d00655

64727329902 Nature-Throid thyroid desiccated 32.5 mg oral tablet oral others d00655

64727707001 Westhroid thyroid desiccated 32.5 mg oral tablet oral others d00655

64727707002 Westhroid thyroid desiccated 32.5 mg oral tablet oral others d00655

64727330201 Nature-Throid thyroid desiccated 48.75 mg oral tablet oral others d00655

64727330202 Nature-Throid thyroid desiccated 48.75 mg oral tablet oral others d00655

00115482401 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00115482403 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00182049310 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00456045900 Armour Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00456045901 Armour Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00456045911 Armour Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00456045963 Armour Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00603605221 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00603605232 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00904076160 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

00904076180 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

12280013100 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

Page 421: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

12280013130 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

42192033001 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

49483002201 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

49483002210 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

49999070230 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

54569091800 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

54868125300 Armour Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

55289026130 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

55289026190 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

63629271301 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

63629271302 Thyroid thyroid desiccated 60 mg oral tablet oral others d00655

64727707508 Westhroid thyroid desiccated 60 mg oral tablet oral others d00655

64727330001 Nature-Throid thyroid desiccated 65 mg oral tablet oral others d00655

64727330002 Nature-Throid thyroid desiccated 65 mg oral tablet oral others d00655

64727707301 Westhroid thyroid desiccated 65 mg oral tablet oral others d00655

64727707302 Westhroid thyroid desiccated 65 mg oral tablet oral others d00655

00456046001 Armour Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

00603605321 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

00603605332 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

23490637701 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

23490637702 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

42192033101 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

49999028100 Armour Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

54569447100 Armour Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

54868515900 Armour Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

Page 422: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

54868515901 Armour Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

66336095260 Thyroid thyroid desiccated 90 mg oral tablet oral others d00655

00247026704 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026705 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026706 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026708 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026710 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026712 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026715 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026720 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247026740 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

20254001801 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

20254001803 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

52152016602 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

52959047910 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

52959047912 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

52959047920 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

52959047930 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

54569340700 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

54868297300 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

54868297302 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

54868297303 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

54868297304 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

55045162803 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

55887074120 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

Page 423: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

58016097300 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097302 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097303 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097308 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097310 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097312 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097315 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097320 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097324 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097330 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097350 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097360 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097373 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097389 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

58016097390 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

66267020810 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

66267020820 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

68115033920 Trimethobenzamide Hydrochloride trimethobenzamide 250 mg oral capsule oral antiemetics d00862

00247209700 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209704 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209705 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209706 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209708 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209709 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209710 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

Page 424: Use of High Risk Medications in the Elderly (DAE)...November 2012 1 Centers for Medicare & Medicaid Services MEASURE SPECIFICATIONS AND DRUG LIST FOR “USE OF HIGH RISK MEDICATIONS

ndc_code brand_name generic_product_name route category drug_id

00247209712 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209730 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

00247209779 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

43386066024 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

43386066026 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

52152018502 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

52959081710 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

53489037601 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

54569558900 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

54569558901 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

54868518100 Tigan trimethobenzamide 300 mg oral capsule oral antiemetics d00862

54868574100 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

55289095306 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

55887008106 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862

61570007901 Tigan trimethobenzamide 300 mg oral capsule oral antiemetics d00862

68115058800 Trimethobenzamide Hydrochloride trimethobenzamide 300 mg oral capsule oral antiemetics d00862