Coverage Decisions for Drugs

Oral fentanyl products

Coverage decision

L&I does not cover oral fentanyl products (see the list below) for the managment of breakthrough non-cancer pain.

Oral fentanyl products are indicated for the management of:

• Breakthrough cancer pain in patients and
• Patients who are already receiving and are tolerant to opioid therapy for their underlying persistent cancer pain.

Patients considered opioid tolerant are those who are taking:

• Morphine 60 mg/day or more,
• Transdermal fentanyl 25 mcg/hour,
• Oxycodone 30mg/day,
• Oral Hydromorphone 8mg/day, or
• An equianalgesic dose of another opioid for 1 week or longer.

The Food and Drug Adminsitration (FDA) has approved the following oral fentanyl products for the management of breakthrough cancer pain:

• Actiq® (fentanyl citrate transmucosal).
• Fentoral® (fentanyl buccal tablet).
• Onsolis® (fentanyl buccal soluble film).