April 6, 2017
We're requiring a quantity limit prior authorization for high-risk opioids beginning July 1, 2017, in accordance with the new recommendations from the Centers for Disease Control and Prevention (CDC) for the safe and effective prescribing of opioids.
| Medication(s) |
Quantity allowed without review |
| Morphine Sulfate ER (Avinza) |
90 capsules of all strengths per 30 days |
| Embeda ER |
90 capsules of all strengths per 30 days |
| Hydromorphone ER (Exalgo) |
60 tablets of all strengths per 30 days |
| Morphine Sulfate ER (Kadian) |
90 capsules of all strengths per 30 days |
| Morphine Sulfate ER (MS Contin) |
120 tablets of all strengths per 30 days |
| Nucynta (all strengths) |
181 tablets/fill |
| Nucynta ER |
60 tablets of all strengths per 30 days |
| Oxymorphone ER (Opana ER) |
90 tablets of all strengths per 30 days |
| Suboxone film 12/3 mg |
60 films/fill |
| Suboxone film 2/0.5 mg, 4/1 mg, 8/2 mg |
90 films/fill |
| Buprenorphine-Naloxone tablet 2/0.5 mg, 8/2 mg |
90 tablets/fill |
| Zubsolv 1.4/0.36 mg, 5.7/1.4 mg |
90 tablets/fill |
| Zubsolv 8.6/2.1 mg |
60 tablets/fill |
What do you need to do?
Review your patient's current dose. If the dose exceeds the new quantity limits, you'll need to submit a prior authorization through electronic prior authorization or fax at 888-260-9836. If you have questions, call Pharmacy Services at 888-261-1756, option 2.