Opioids, Long-Acting
PDL Reference Documents
- Buprenorphine - Feb 02, 2023
- Opioids Literature Scan - Apr 01, 2021
- Opioids Literature Scan - Feb 06, 2020
- Opioids - Sep 26, 2019
- Fibromyalgia Indication Review - Jan 24, 2019
- Tramadol Evidence Summary Review - Mar 23, 2017
- Opioid Analgesics - Nov 17, 2016
- Long-acting Opioids - May 26, 2016
- Long-acting Opioids Class Update - Mar 26, 2015
- Long Acting Opioids Scan Summary - Mar 27, 2014
- Long Acting Opioids DRP Scan - Mar 27, 2014
- Abbreviated Class Update: Long-Acting Opioids (LAOs) - Sep 26, 2013
- Abbreviated Class Update: Long-Acting Opioids (LAOs) - Jul 25, 2013
Drug Use Review Documents
- Buprenorphine Duration Drug Use Evaluation - Jun 02, 2022
- Buprenorphine Indication Drug Use Evaluation - Jun 02, 2022
- Buprenorphine Polypharmacy Drug Use Evaluation - Jun 02, 2022
- Concurrent Use of Opioids and CNS depressants - Jul 25, 2019
- Methadone - May 24, 2018
- High Dose Opioids Drug Use Evaluation - Mar 26, 2015
- Drug Use Evaluation: Long-Acting Opioids - Jan 26, 2012
Newsletters
- May 2023 - Buprenorphine: Place in Therapy for Chronic Pain
- November 2019 - Update on Recent Guidance and Safety Alerts for Opioid Use in Non-cancer Pain
- July 2017 - Tramadol and Codeine Use In Pediatrics: A Review of Recent FDA Safety Alerts
- December 2016 - Guideline and Policy Updates for Use of Opioids for Non-Cancer Pain and Opioid Use Disorder
- March 2015 - Combating the Opioid Epidemic: Are Abuse-deterrent Formulations the Answer?
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
|---|---|---|---|---|---|
| fentanyl | FENTANYL | PATCH TD72 | Y | PA Document | |
| morphine sulfate | MORPHINE SULFATE ER | TABLET ER | Y | PA Document | |
| morphine sulfate | MS CONTIN | TABLET ER | Y | PA Document | |
| buprenorphine | BUPRENORPHINE | PATCH TDWK | N | PA Document | |
| buprenorphine | BUTRANS | PATCH TDWK | N | PA Document | |
| buprenorphine HCl | BELBUCA | FILM | N | PA Document | |
| fentanyl | FENTANYL | PATCH TD72 | N | PA Document | |
| hydrocodone bitartrate | HYDROCODONE BITARTRATE ER | CAP ER 12H | N | PA Document | |
| hydrocodone bitartrate | HYDROCODONE BITARTRATE ER | TAB ER 24H | N | PA Document | |
| hydrocodone bitartrate | HYSINGLA ER | TAB ER 24H | N | PA Document | |
| hydromorphone HCl | HYDROMORPHONE ER | TAB ER 24H | N | PA Document | |
| levorphanol tartrate | LEVORPHANOL TARTRATE | TABLET | N | PA Document | |
| methadone HCl | METHADOSE | ORAL CONC | N | PA Document | |
| methadone HCl | METHADONE INTENSOL | ORAL CONC | N | PA Document | |
| methadone HCl | METHADONE HCL | ORAL CONC | N | PA Document | |
| methadone HCl | METHADONE HCL | SOLUTION | N | PA Document | |
| methadone HCl | METHADONE HCL | TABLET | N | PA Document | |
| methadone HCl | METHADOSE | TABLET SOL | N | PA Document | |
| methadone HCl | METHADONE HCL | TABLET SOL | N | PA Document | |
| morphine sulfate | MORPHINE SULFATE ER | CAP ER PEL | N | PA Document | |
| morphine sulfate | MORPHINE SULFATE ER | CPMP 24HR | N | PA Document | |
| oxycodone HCl | OXYCODONE HCL ER | TAB ER 12H | N | PA Document | |
| oxycodone HCl | OXYCONTIN | TAB ER 12H | N | PA Document | |
| oxymorphone HCl | OXYMORPHONE HCL ER | TAB ER 12H | N | PA Document | |
| tramadol HCl | CONZIP | CPBP 17-83 | N | PA Document | |
| tramadol HCl | TRAMADOL HCL ER | CPBP 17-83 | N | PA Document | |
| tramadol HCl | CONZIP | CPBP 25-75 | N | PA Document | |
| tramadol HCl | TRAMADOL HCL ER | CPBP 25-75 | N | PA Document | |
| tramadol HCl | TRAMADOL HCL ER | TAB ER 24H | N | PA Document | |
| tramadol HCl | TRAMADOL HCL ER | TBMP 24HR | N | PA Document |