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:

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.