Drug - Long acting opioids
June 2019
Therapeutic area - Pain
Preferred | Nonpreferred |
Butrans+
Fentanyl (25, 50 mg) Transdermal Morphine ER Tablets |
Arymo ER
Belbuca+ Buprenorphine Transdermal+ Duragesic Matrix Embeda Exalgo Fentanyl Transdermal (12.5 mg, 37.5mg, 62.5mg, 75 mg, 87.5mg, 100 mg) Hydromorphone ER Hysingla ER* Kadian Methadone Morphine ER Capsule (Avinza) Morphine ER Capsule (Kadian) MS Contin Nucynta ER** Opana ER*** Oxycodone HCl ER Oxycontin Oxymorphone ER Xtampza ER Zohydro ER* |
* See PA criteria sheet: Zohydro (Hysingla ER and Zohydro ER)
** See PA criteria sheet: Nucynta ER
*** See PA criteria sheet: Opioids: Opana/ER
+See PA criteria sheet: Buprenorphine Transdermal Patch and Buccal Film
Morphine intolerance is defined as:
Limit on Days’ Supply of the First Opioid Prescription
The first opioid prescription, based on Fee-for-Service Medicaid’s prescription claim history of 90 days, will be limited to no more than 7-day supply.
Authorization may be granted for first opioid prescription’s 7-day limit override if:
Authorization may NOT be granted for 7-day limit override if:
Daily Limit of Opioid Prescriptions
Opioid prescriptions are limited to a maximum dose of 90 morphine equivalents per day (MED). Opioid prescriptions written for doses greater than 90 MED require prior authorization. To request prior authorization, the following forms must be completed and faxed to MHCP Prescription Drug PA Review Agent:
Quantity limits for Oxycontin or oxycodone sustained release
Oral opioid expected equianalgesic dosing – (represents total daily dose)
Strengths and doses | Oxycodone total daily dose | Morphine daily dose range |
Strengths available | 10, 15, 20, 30, 40, 60, 80mg | 15, 30, 60, 100 mg |
Dosing frequency | Twice daily | Twice daily |
Oxycodone dose and morphine dose ranges | 20 mg | 30 - 40 mg |
30 mg | 45 - 60 mg | |
40 mg | 60 - 80 mg | |
60 mg | 90 - 120 mg | |
80 mg | 120 - 160 mg | |
100 mg | 150 - 200 mg |
These recommendations are guides only. Individual patients require doses to be adjusted.
Methadone (5 and 10 mg) is long acting by its pharmacokinetic properties, not by tablet formulation. It is expected to be about equipotent to oxycodone.
MHCP Provider Call Center 651-431-2700 or 800-366-5411