buprenorphine/naloxone (Suboxone, Zubsolv, Bunavail)

SELF ADMINISTRATION - Oral

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)