Coverage Decisions for Drugs

Buprenorphine (Butrans) Transdermal System

Coverage decision

L&I will cover on an exception basis buprenorphine transdermal system when the patient requires continuous opioid analgesia for pain that cannot be managed by lesser means AND:

  1. Has tried and failed two (2) preferred opioids
    AND
  2. Was previously maintained on ≤ 80mg/d of morphine equivalent dose (MED) with current daily opioid dose tapered to ≤ 30mg/d MED before starting buprenorphine transdermal system.

Note: This does not apply to the use of opioids in the treatment of cancer pain.

Non-oral routes of administration of scheduled drugs that result in systemic availability of the drug equivalent to injectable routes will not be covered (see WAC 296-20-03014 (2)).  L&I has reviewed the literature and safety profile of buprenorphine transdermal system. While the drug is absorbed relatively slowly, it reaches peak levels equivalent to intravenous use. Therefore, because the pharmacokinetics of transdermal buprenorphine demonstrates systemic availability that is equivalent to injectable routes, this product will not be routinely covered.


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