Anthem Blue Cross (HMO, PPO, EPO)
Belbuca (buprenorphine HCl)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Pain Narcotic: Opioid:
    Duration: 1 year(s)
    Documented Diagnosis: No
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Used for Cancer Patients: No
    Around-The-Clock Analgesic Required: No
    Morphine Equivalent Dose (MED) Limit: N/A
    Morphine Equivalent Dose (MED) Required: No

  • 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;
  • Step Therapy: Pain Narcotic: Opioid:
    ST Multiple Generics

  • Quantity Limit: 2 films per 1 day(s).
  • Prior Authorization: Pain Narcotic: Opioid:
    Duration: 1 year(s)

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