skip to content
Primary navigation


Drug - Actiq (transmucosal fentanyl); transmucosal fentanyl generic; Abstral (sublingual tablets); Fentora (fentanyl buccal tablet); Lazanda (fentanyl citrate nasal spray); Onsolis (fentanyl buccal film); Subsys (fentanyl sublingual spray)

November 2014

Therapeutic area - break through cancer pain


Authorized only for approved indication and per the package black box warning on each product, which reads as follows:

  • [product name] is indicated only for the management of breakthrough cancer pain in patients with malignancies who are already receiving and who are tolerant to opioid therapy for their underlying persistent cancer pain.

Payment for Actiq or its generic (transmucosal fentanyl) will be authorized if:

  • The patient is at least 16 years of age AND
  • The patient has an active diagnosis of cancer AND
  • The Actiq unit is intended for use for breakthrough cancer pain AND
  • The patient shows evidence of concurrent use of other long-acting opioid AND
  • The patient has tried and failed immediate release morphine and immediate release oxycodone OR
  • The patient is allergic to morphine and oxycodone AND
  • The patient is not concurrently taking ritonavir (Norvir), or if patient is concurrently taking ritonavir, physician is aware of potential for increased fentanyl AUC [Ritonavir decreased the clearance of fentanyl by 67%, resulting in a 174% (range 52%-420%) increase in fentanyl AUC]

Payment for Abstral (sublingual tablets), Fentora (buccal tablet), Lazanda (fentanyl citrate nasal spray), Subsys (fentanyl sublingual spray) and Onsolis buccal (film) will be authorized only if:

  • The patient is at least 18 years of age AND
  • The patient has tried the Actiq lozenge or its generic equivalent and meets all other criteria points listed above to obtain Actiq or its generic equivalent and has not had adequate pain relief when used at the highest strength as documented in the patient’s chart


MHCP Provider Call Center 651-431-2700 or 800-366-5411

back to top