| Anthem Blue Cross (HMO, PPO, EPO) |
| Nucynta ER (tapentadol) |
| Drugs for Pain and Fever : Arthritis and Pain Drugs |
- Step Therapy Applies
- Pain Narcotic: Opioid:
Age Requirement: >= 18
Duration: 3 Month(s)
Documented Diagnosis: Yes
Medical Test Required: No
Reauthorization Required: Yes
Duration of Reauthorization: = 6 month(s)
Diagnosis Type(s): Severe Pain
Used for Cancer Patients: Yes
Around-The-Clock Analgesic Required: Yes
Morphine Equivalent Dose (MED) Limit: N/A
Morphine Equivalent Dose (MED) Required: No
- Quantity Limit: 2 tablets per 1 day(s).
- Prior Authorization: Pain Narcotic: Opioid:
Documented Diagnosis: Yes
Age Requirement: >= 18
Duration: 3 Month(s)
Reauthorization Required: Yes
- PA Applies
For FAX form click HERE
Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. Creating an account is free, easy and helps patients get their medications sooner. You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites:
Log in to Surescripts
Log in to CoverMyMeds; For details on drug coverage click HERE;
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