Announcement from CareSource to Ohio Health Partners – Medicaid
Attention Health Partners:
To further support your efforts in treating patients with opioid use disorder, CareSource has made a change to our drug formulary. Effective July 1, 2018, preferred buprenorphine and buprenorphine/naloxone products will no longer require prior authorization. The preferred agents in this class are generic sublingual (SL) tablets.
Please note that the Bunuvail films, Suboxone films, and Zubsolv SL tablets are non-preferred. As a result, the non-preferred buprenorphine/naloxone products will require a trial of the preferred generic sublingual tablets within the previous 120 days or a review to determine medical necessity for the non-preferred agent. Criteria will require one of the following:
-For patients with a hypersensitivity reaction to an inactive ingredient in the preferred generic buprenorphine/naloxone product, the reaction must be clearly documented in the patient’s medical record.
-For patients who experience therapeutic failure or an adverse outcome with the preferred generic buprenorphine/naloxone product, confirmation of reporting the aforementioned event to the FDA or a MedWatch Form to the FDA is required. Please note that the Suboxone files, Zubsolv SL tablets, or Bunuvail films will not be approved for patients who report lesser efficacy with the generic buprenorphine/naloxone SL tablets unless it would be clinically inappropriate to address efficacy with dose adjustment.
If you have questions, call CareSource at 1-800-488-0134 and follow the prompts to Pharmacy. Representatives are available Monday through Friday, 8 a.m. to 5 p.m. Eastern Time.