Anthem Blue Cross (HMO, PPO, EPO) |
Suboxone (buprenorphine-naloxone) |
Drugs for Addiction : Drugs for Opioid Addiction |
- Substance Abuse: Opioid Dependence:
Age Requirement: >= 16
Duration: 3 Month(s)
Medical Test Required: No
Reauthorization Required: No
Negative Test for Opioids: Yes
Rehabilitation Program Required: Yes
Policy Specifies Induction or Initiation of Therapy: No
Documented Diagnosis: No
Induction Period Specified: No
- Quantity Limit: 6 films per 1 day(s).
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;
- Prior Authorization: Substance Abuse: Opioid Dependence:
PA Applies
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