DHS COVID-19 PROVIDER RESOURCES // OMAP
MCOPS Memo #05/2020-013: Removal of Prior Authorization for Sublocade (buprenorphine extendedrelease) Injection
Issued: May 26, 2020
Audience
All Physical Health (PH) HealthChoices Managed Care Organizations (MCOs) –
Statewide
Purpose
To notify the HealthChoices PH-MCOs of the removal of Prior Authorization for
SublocadeTM (buprenorphine extended-release) Injection.
Background
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).
Discussion
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
authorization.
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.
Next Steps
PH-MCOs should align their policies with the guidance issues in this operations
memorandum.
Obsolete
This MC OPS Memo will remain in effect until further notice.