Buprenorphine or buprenorphine/naloxone

Coverage decision - Effective July 1, 2013

Prior authorization is required for buprenorphine and buprenorphine/naloxone products. L&I may cover buprenorphine (Subutex®) or buprenorphine/naloxone (Suboxone®) for a limited time to aid in opioid weaning or opioid use disorder, but does not provide coverage for pain management or other off-label uses.

Coverage criteria

Opioid wean

The requesting provider must:

• provide documentation of a time-limited opioid taper plan and
• have a current DATA 2000 waiver to prescribe buprenorphine and buprenorphine/naloxone. To verify whether a provider has a valid DATA waiver, use the Buprenorphine Locator at http://buprenorphine.samhsa.gov/bwns_locator/dr_facilitylocatordoc.htm

Authorization is limited to 30 days. An additional 30 days is available if requested and progress on the opioid wean has been documented.

Opioid use disorder

The requesting provider must:

• document that the worker has failed steps 1 and 2 taper (see WAC 296-20-03030)
• document that the worker is diagnosed with opioid use disorder and this condition is identified as a barrier to recovery; and
• submit a time-limited plan documenting how temporary treatment of this condition through a licensed chemical dependency treatment center will allow significantly improved work capacity and/or the ability to progress in vocational retraining.

Payment for treatment of opioid use disorder is limited to six months per worker.

For more information:
Contact information.