SUBLOCADE (buprenorphine ER)

SUBLOCADE (buprenorphine ER)

OFFICE ADMINISTRATION, PHARMACIST ADMINISTRATION - INJ

Indications for Prior Authorization:

• Treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a transmucosal buprenorphine-containing product, followed by dose adjustment for a minimum of 7 days

Patients must meet the following criteria for the indication(s) above:

• Diagnosis of opioid use disorder
• Member is at least 18 years of age
• Member has been treated with a transmucosal buprenorphine-containing product delivering the equivalent of 8-24mg of buprenorphine daily for at least 7 days
• Medical justification supports inability to continue to use oral (e.g. sublingual, buccal) formulations of buprenorphine
• Not to exceed 300mg per month

For Reauthorization:

• Member is responding positively to therapy
• The member has not received an opioid analgesic since the last approval (or prescriber submits documentation that the use of an opioid since the last approval was due to a diagnosis of acute pain)

Dosing:

• For abdominal subcutaneous injection only
• Only healthcare providers should prepare and administer Sublocade
• Initial: 300mg monthly for the first two months
• Maintenance: 100mg monthly
  • The maintenance dose may be increased to 300mg monthly for patients who tolerate the 100mg dose, but do not demonstrate a satisfactory clinical response, as evidenced by self-reported illicit opioid use or urine drug screens positive for illicit opioid use
• A patient who misses a dose should receive the next dose as soon as possible, with the following dose given no less than 26 days later. Occasional delays in dosing up to 2 weeks are not expected to have a clinically significant impact on treatment effect

Approval:

• 6 months