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    Long Acting Opioids

    Drug - Long acting opioids

    November 2018

    Therapeutic area - Pain

    Drugs

    Preferred Nonpreferred
    Morphine ER Tablets Arymo ER
    Butrans+ Belbuca+
    Buprenorphine Transdermal+
    Duragesic Matrix
    Embeda
    Exalgo
    Fentanyl Transdermal (37.5mg, 62.5mg, 87.5mg)
    Hydromorphone ER
    Hysingla ER*
    Kadian
    Methadone 
    Morphine ER Capsule (Avinza)
    Morphine ER Capsule (Kadian)
    MS Contin
    Nucynta ER**
    Opana ER***
    Oxycodone HCl ER
    Oxycontin
    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

    Approval criteria for nonpreferred products

    • Patient must try at least sustained release morphine (morphine ER) and fail by ineffectiveness at equivalent dosing OR by intolerance AND
    • Presence of a patient-specific pain management plan accompanies each request and is updated at least yearly OR
    • If the request is for Duragesic, patient has an adequate adherent trial and failure of (or contraindication to) fentanyl transdermal patches
    • Patient has cancer-related pain and has been stabilized on requested nonpreferred drug

    Morphine intolerance is defined as:

    • Patient has renal insufficiency
    • Patient has a true morphine allergy (as manifested by skin rash, facial swelling, or difficulty breathing)
    • Patient develops morphine-related itching
    • Patient cannot tolerate the nausea and vomiting of morphine 

    Quantity Limits

    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:

    • Correct calculated day supply per prescriber direction is verified AND
    • The member has a diagnosis of cancer OR
    • The member is currently undergoing palliative care and NOT hospice care OR
    • The request is for a retro-eligibility claim OR
    • The request is for a TPL claim where the TPL paid for over 60% of the allowable amount OR
    • The member has a medically necessary travel plan OR
    • The request is for a bridge of service

    Authorization may NOT be granted for 7-day limit override if:

    • The member does NOT have a medically necessary travel plan
    • A follow-up appointment can be made before 7-day supply is depleted

    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.

    Questions?

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

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