DHS COVID-19 PROVIDER RESOURCES // OMAP
MCOPS Memo #05/2020-013: Removal of Prior Authorization for Sublocade (buprenorphine extendedrelease) Injection
Issued: May 26, 2020
All Physical Health (PH) HealthChoices Managed Care Organizations (MCOs) –
To notify the HealthChoices PH-MCOs of the removal of Prior Authorization for
SublocadeTM (buprenorphine extended-release) Injection.
SublocadeTM (buprenorphine extended-release) injection is a once-monthly injection
indicated for the treatment of opioid use disorder. It is a preferred medication in
the Opioid Dependence Treatments class on the Pennsylvania Medical Assistance
Statewide Preferred Drug List (PDL).
The prior authorization guidelines for Opioid Dependence Treatments have been
revised to indicate that prescriptions for SublocadeTM (buprenorphine extendedrelease) injection that do not exceed the quantity limit no longer require prior
The Statewide PDL can be viewed at www.papdl.com.
Prior authorization guidelines for Opioid Dependence Treatments can be found on
the MCO websites and the Department’s website at www.dhs.pa.gov/providers/Pharmacy-Services/Pages/ClinicalGuidelines.aspx.
PH-MCOs should align their policies with the guidance issues in this operations
This MC OPS Memo will remain in effect until further notice.