Buprenorphine ER (Sublocade)

OFFICE ADMINISTRATION, PHARMACIST ADMINISTRATION - INJ

Indications for Prior Authorization:

  • Treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a transmucosal buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days

Patients must meet the following criteria for the indication(s) above:

  • Diagnosis of opioid use disorder
  • Member is at least 18 years of age
  • Member has been treated with a transmucosal buprenorphine-containing product delivering the equivalent of 8-24mg of buprenorphine daily for at least 7 days
  • Medical justification supports inability to continue to use oral (e.g. sublingual, buccal) formulations of buprenorphine
  • Not to exceed 300mg per month

For Reauthorization:

  • Member is responding positively to therapy
  • The member has not received an opioid analgesic since the last approval (or prescriber submits documentation that the use of an opioid since the last approval was due to a diagnosis of acute pain)

Dosing:

  • For abdominal subcutaneous injection only
  • Only healthcare providers should prepare and administer Sublocade
  • Initial: 300mg monthly for the first two months
  • Maintenance: 100mg monthly
    • The maintenance dose may be increased to 300mg montly for patients who tolerate the 100mg dose, but do not demonstrate a satisfactory clinical response, as evidenced by self-reported illicit opioid use or urine drug screens positive for illicit opioid use
  • A patient who misses a dose should receive the next dose as soon as possible, with the following dose given no less than 26 days later. Occasional delays in dosing up to 2 weeks are not expected to have a clinically significant impact on treatment effect

Approval:

  • 6 months

Last review date: April 22, 2019