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SoonerSelect enrollment is open through June 13! It’s your chance to pick or change your health and dental plans. Make changes in the member portal or call 800-987-7767.

Muscle Relaxants

PHARM-13 Statement of Medical Necessity for Quantity Limits Override.

Muscle Relaxants

Drugs

Quantity Limits

Amrix (Cyclobenzaprine HCL) 15mg and 30mg SR Capsules

 30 Capsules per 30 Days

Fexmid (Cyclobenzaprine HCL) 7.5mg Tablets 

 90 Tablets per 30 Days

Soma (Carisoprodol) 250mg and 350mg Tablets 

 120 Tablets per 30 Days

Soma Compound (Carisoprodol - Aspirin) 200mg - 325mg Tablets 

 120 Tablets per 30 Days

 

Last Modified on Nov 10, 2020
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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.