buprenorphine/naloxone (Suboxone, Zubsolv, Bunavail)


Indications for Prior Authorization

treatment of opioid dependence

Patients must meet the following criteria for the indications above.

Providers must receive specialized training and be certified to prescribe buprenorphine/naloxone.

buprenorphine/naloxone sublingual tablets is the preferred agent

Use of any other product requires chart note documentation of trail/failure/intolerable side effects to the sl tabs.

The Following Conditions Do Not Meet the Criteria for Use as Established by the WHA P & T Committee.

  • pain
  • chronic narcotic maintenance is not a covered benefit
  • any diagnosis not listed above as a covered indication

Treatment Phases

Induction: The goal of induction is to safely suppress opioid withdrawal as rapidly as possible with adequate doses of buprenorphine/naloxone sl tablets. Patients cannot begin their induction to buprenorphine/naloxone sl tablets (and off of their previous opioid) until they are experiencing mild-to-moderate withdrawal symptoms.

Induction is complete when the patient experiences no withdrawal symptoms, no uncontrollable opioid cravings, and minimal to no side effects. The induction phase usually averages about 2 to 5 days.

Stabilization: During stabilization, the patient's buprenorphine/naloxone sl tablets dose is "fine-tuned." The objective is to find the minimum dose necessary to keep the patient in treatment. After each dose adjustment, 3 to 7 days should be allowed for steady-state blood levels to be achieved. Stabilization can last anywhere from a week to several weeks. The maximum FDA approved dose is 24 mg per day.

Maintenance: The goals of the maintenance phase are to prevent opioid withdrawal symptoms, suppress opioid cravings, and greatly attenuate the use of self-administered opioids. Patients may be maintained on buprenorphine/naloxone sl tablets from a maximum of 12months before initiation of Medically Supervised Withdrawal.

Medically supervised withdrawal: In this phase, the buprenorphine/naloxone sl tablets dose is slowly tapered. Mild withdrawal symptoms are possible as the buprenorphine/naloxone sl tablets dose declines.


Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: December 2014                               Reviewed:

Reviewed and approved by Dr. R. Shain (Magellan Behavior Health)