Buprenorphine and or buprenorphine/naloxone transmucosal

Coverage decision

Buprenorphine and buprenorphine/naloxone transmucosal products require prior authorization. We may cover it for a limited time under the following circumstances, but not for pain management or other off-label uses.

For opioid wean

You must:

• Provide documentation of a time-limited opioid taper plan; and
• Have a current DATA 2000 waiver to prescribe buprenorphine; and buprenorphine/naloxone products. Use the Buprenorphine Locator to verify DATA-waived providers (www.samhsa.gov).

Authorization is limited to 30 days. Upon your request, an additional 30 days is available if you have documented progress on the opioid wean.

For opioid use disorder

You must:

• Document that your patient has failed steps 1 and 2 taper (see WAC 296-20-03030);
• Document that your patient is diagnosed with opioid use disorder by DSM V criteria and this condition is identified as a barrier to recovery; and,
• Submit a time-limited plan documenting how temporary treatment of this condition 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 claimant.