Tramadol products

Coverage decision

L&I recognizes tramadol as an opioid. Payment for tramadol products including the combination with acetaminophen is subject to L&I's opioid rules and guidelines. This determination is made regardless of the risk level for potential abuse or whether it has "pure" opiate agonist properties.

Tramadol is a centrally acting analgesic medication. Its pharmacologic effect is due to the binding of both parent and metabolite, M1, to μ-opioid receptors as well as inhibiting the reuptake of norepinephrine and serotonin. As such, tramadol is recognized as an opiate agonist by the American Hospital Formulary Service (AHFS) Pharmacologic-Therapeutic Classification.

The Food and Drug Administration has approved the following tramadol products:

• Ultram® (tramadol) is approved for management of moderate to moderately severe pain in adults.
• Ultram ER® and Ryzolt® (tramadol extended-release) are indicated for management of moderate to moderately severe pain in adults who require around-the-clock treatment of pain for an extended period of time.
• Ultracet® (tramadol with acetaminophen) is indicated for the short-term (5 days or less) management of acute pain.

For more information:
See Pharmacy Services' Opioid Rules site.

See WAC 296-20-03019 through 296-20-03023 for payment of opioids to treat chronic, noncancer pain.