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Zubsolv

Drug - buprenorphine with naloxone, Zubsolv® (CIII) - Dose Forms: sublingual tablets

April 2014

Therapeutic Area - Drugs for opiate dependency, receptor opioid agonist 

Authorization duration

3 months

Buprenorphine/naloxone 5.7 mg - 1.4 mg sublingual tablets

Approval Criteria

  • The prescription written is for a patient who has been diagnosed with opiate dependency and the medication is intended for use as detoxification or maintenance of opiate dependency AND 
  • The physician prescribing is authorized by the Drug Enforcement Agency (DEA) to prescribe medications for opiate dependent individuals as evidenced by a DEA registration number to prescribe Subutex, Suboxone or Zubsolv AND 
  • The prescriber has documentation that they actively review the patient’s drug profile on the Prescription Drug Monitoring database AND
  • The prescriber has documentation that they have tried and failed Suboxone film 2 mg - 0.5 mg or Suboxone film 8 mg - 2 mg
  • No more than two active PA’s are allowed at one time

Buprenorphine/naloxone (Zubsolv) 1.4 mg - 0.36 mg sublingual tablets

Approval Criteria

  • The prescription written is for a patient who has been diagnosed with opiate dependency and the medication is intended for use as detoxification or maintenance of opiate dependency AND 
  • The physician prescribing is authorized by the Drug Enforcement Agency (DEA) to prescribe medications for opiate dependent individuals as evidenced by a DEA registration number to prescribe Subutex, Suboxone or Zubsolv AND
  • The prescriber has documentation that they actively review the patient’s drug profile on the Prescription Drug Monitoring database
  • The prescriber has documentation that they have tried and failed Suboxone film 2 mg - 0.5 mg or Suboxone film 8 mg - 2 mg
  • No more than two active PA’s are allowed at one time

Quantity limits for buprenorphine-naloxone

buprenorphine-naloxone strength Quantity limit
1.4mg-0.36mg (Zubsolv) 34
5.7mg-1.4mg (Zubsolv) 34

Questions?

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

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