TennCare Morphine Milligram Equivalent (MME) Conversion Chart January 1, 2020 This is a current list of the MME conversions. This list is subject to change. Go to the following link to see the most current version: https://www.optumrx.com/oe_tenncare/prescriber MME/ Generic Label Name Drug Strength Dosage Form Example Product(s) Unit ACETAMINOPHEN WITH CODEINE 120-12 MG/5 APAP-CODEINE, TYLENOL with 0.36 ML CODEINE 240-24 MG/10 SUSPENSION 0.36 ML 300-30 0.36 MG/12.5 ML 300-15 MG 2.25 300-30 MG TABLET 4.5 300-60 MG 9 BENZHYDROCODONE/ ACETAMINOPHEN 4.08-325 MG APADAZ 5 6.12-325 MG TABLET 7.5 8.16-325 MG 10 BUPRENORPHINE 5 MCG/HR BUPRENORPHINE, BUTRANS 63 7.5 MCG/HR 94.5 10 MCG/HR PATCH 126 20 MCG/HR 252 15 MCG/HR 189 BUPRENORPHINE HCL 75 MCG BELBUCA 2.25 150 MCG 4.5 300 MCG 9 450 MCG FILM 13.5 600 MCG 18 750 MCG 22.5 900 MCG 27 CODEINE SULFATE 15 MG CODEINE SULFATE 2.25 30 MG TABLET 4.5 60 MG 9 FENTANYL 12 MCG/HR DURAGESIC PATCH, FENTANYL 86.4 25 MCG/HR PATCH 180 37.5 MCG/HR 270 50 MCG/HR 360 PATCH 62.5 MCG/HR 450 75 MCG/HR 540 87.5 MCG/HR 630 100 MCG/HR 720 HYDROCODONE BITARTRATE 20 MG HYSINGLA 20 30 MG 30 40 MG 40 60 MG TABLET 60 80 MG 80 100 MG 100 120 MG 120 10 MG ZOHYDRO ER 10 15 MG 15 20 MG 20 CAPSULE 30 MG 30 40 MG 40 50 MG 50
Proprietary & Confidential © 2020, OptumRx. All Rights Reserved. MME/ Generic Label Name Drug Strength Dosage Form Example Product(s) Unit HYDROCODONE/ ACETAMINOPHEN 2.5-325 MG NORCO, HYDROCODONE/APAP 2.5 5-325 MG VICODIN, LORCET, LORTAB, XODOL 5 5-300 MG 5 7.5-325 MG TABLET 7.5 7.5-300 MG 7.5 10-325 MG 10 10-300 MG 10 2.5-108 MG/5 HYDROCODONE/APAP, LORTAB, 0.5 ML ZAMICET 5-217 MG/10 0.5 ML 5-163 0.67 MG/7.5ML SOLUTION 7.5-325 0.5 MG/15 ML 10-300 MG/15 0.67 ML 10-325 MG/15 0.67 ML HYDROCODONE/ IBUPROFEN 2.5-200 MG REPREXAIN, HYDROCODONE-IBU 2.5 5-200 MG TABLET 5 10-200 MG 10 HYDROMORPHONE HCL 3 MG SUPPOSITORY HYDROMORPHONE, DILAUDID, 12 1 MG/ML SOLUTION EXALGO ER 4 2 MG 8 4 MG 16 8 MG TABLET 32 16 MG 64 32 MG 128 IBUPROFEN/ OXYCODONE HCL 400-5 MG TABLET OXYCODONE-IBUPROFEN 7.5 LEVORPHANOL TARTRATE 2 MG TABLET LEVORPHANOL 22 3 MG TABLET 33 MEPERIDINE HCL 50 MG MEPERIDINE 5 TABLET 100 MG 10 50 MG/5 ML SOLUTION 1 METHADONE HCL 5 MG DOLOPHINE, METHADONE, 20 TABLET 10 MG METHADOSE 40 40 MG TABLET DISPR 320 5 MG/5 ML 8 SOLUTION 10 MG/ML 80 MORPHINE SULFATE 5 MG MORPHINE IR, MORPHINE ER, 5 10 MG AVINZA, KADIAN 10 SUPPOSITORY 20 MG 20 30 MG 30 10 MG/5 ML 2 20 MG/5 ML SOLUTION 4 100 MG/5 ML 20 15 MG 15 30 MG 30 60 MG TABLET 60 100 MG 100 200 MG 200 10 MG 10 20 MG 20 CAPSULE 30 MG 30 40 MG 40
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MME/ Generic Label Name Drug Strength Dosage Form Example Product(s) Unit 45 MG 45 50 MG 50 60 MG 60 75 MG 75 80 MG 80 90 MG 90 100 MG 100 120 MG 120 200 MG 200 MORPHINE SULFATE/NALTREXONE 20-0.8 MG EMBEDA ER 20 30-1.2 MG 30 50-2 MG 50 CAPSULE 60-2.4 MG 60 80-3.2 MG 80 100-4 MG 100 OXYCODONE HCL 5 MG/5 ML OXYCODONE, OXAYDO, 1.5 SOLUTION 20 MG/ML ROXICODONE, OXYCONTIN, 30 5 MG ROXYBOND 7.5 7.5 MG 11.25 10 MG 15 15 MG 22.5 20 MG TABLET 30 30 MG 45 40 MG 60 60 MG 90 80 MG 120 5 MG CAPSULE 7.5 OXYCODONE HCL/ ACETAMINOPHEN 5-325 MG/5 OXYCODONE-APAP, ENDOCET, SOLUTION 1.5 ML PRIMLEV, PERCOCET 2.5-325 MG 3.75 5-325 MG 7.5 5-300 MG 7.5 7.5-325 MG TABLET 11.25 7.5-300 MG 11.25 10-325 MG 15 10-300 MG 15 OXYCODONE MYRISTATE 9 MG XTAMPZA ER 13.5 13.5 MG 20.25 18 MG CAPSULE 27 27 MG 40.5 36 MG 54 OXYMORPHONE HCL 5 MG OXYMORPHONE, OPANA, OPANA 15 7.5 MG ER 22.5 10 MG 30 15 MG TABLET 45 20 MG 60 30 MG 90 40 MG 120 TAPENTADOL HCL 50 MG NUCYNTA, NUCYNTA ER 20 75 MG 30 100 MG 40 TABLET 150 MG 60 200 MG 80 250 MG 100 TRAMADOL HCL 50 MG TABLET 5
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MME/ Generic Label Name Drug Strength Dosage Form Example Product(s) Unit 100 MG 10 200 MG 20 300 MG 30 ULTRAM, TRAMADOL, TRAMDOL 100 MG 10 ER, CONZIP 150 MG 15 CAPSULE 200 MG 20 300 MG 30 TRAMADOL HCL/ ACETAMINOPHEN 37.5-325 MG TABLET TRAMADOL-APAP 3.75
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