Opioid transmucosal products (see the list below) are not routinely covered. On an exception basis, we may cover when a patient:
- Has an accepted cancer claim AND,
- Requires treatment for moderate-to-severe breakthrough cancer pain AND,
- Demonstrated opioid tolerance.
Opioid tolerance is defined as taking opioids, for a week or longer, at least:
- Morphine 60mg/day,
- Oxycodone 30mg/day,
- Hydromorphone 8mg/day or
- An equianalgesic dose of another opioid.
List of opioid transmucosal products:
- Fentanyl buccal tablet/soluble film (Fentora/Onsolis)
- Fentanyl nasal spray (Lazanda)
- Fentanyl sublingual tablet/spray (Abstral/Subsys)
- Fentanyl transmucosal lozenge (Actiq)
- Sufentanil sublingual tablet (Dsuvia)
We have reviewed the literature and safety profile of opioid transmucosal products. The pharmacokinetics of opioid transmucosal products demonstrate systemic availability that are equivalent to injectable routes. See WAC 296-20-03014(2).