April 2019
Therapeutic area - Opiate Dependence Treatment
Preferred
Nonpreferred
The prescriber should document that they actively review the patient’s drug profile on the Prescription Drug Monitoring database.
Drug | Quantity limit per 34 days |
Bunavail 2.1-0.3 mg film | 68 |
Bunavail 4.2-0.7 mg film | 68 |
Bunavail 6.3-1 mg film | 68 |
Buprenorphine 2mg sublingual tablet | 136 |
Buprenorphine 8mg sublingual tablet | 102 |
Buprenorphine-naloxone 2mg-0.5mg sublingual tablet | 136 |
Buprenorphine-naloxone 8mg-2mg sublingual tablet | 102 |
Buprenorphine-naloxone 8mg-2mg film | 102 |
Suboxone 2mg-0.5mg film | 102 |
Suboxone 4mg-1mg film | 102 |
Suboxone 8mg-2mg film | 102 |
Suboxone 12mg-3mg film | 68 |
Zubsolv 0.7-0.18mg sublingual tablet | 68 |
Zubsolv 14-0.36mg sublingual tablet | 68 |
Zubsolv 2.9-0.71mg sublingual tablet | 68 |
Zubsolv 5.7-1.4mg sublingual tablet | 68 |
Zubsolv 8.6-2.1mg sublingual tablet | 68 |
Zubsolv 11.4-2.9mg sublingual tablet | 34 |
Questions?
MHCP Provider Call Center 651-431-2700 or 800-366-5411