Fentanyl transdermal products are not routinely covered. On an exception basis, we may cover it when a patient:
- Demonstrated opioid tolerance AND,
- Requires continuous opioid analgesia that cannot be managed by lesser means, such as non-steroidal analgesics, opioid combination products, or immediate-release opioids AND,
- Cannot tolerate other long-acting opioids OR,
- Has a medical contraindication to the use of oral opioids (e.g., the patient cannot swallow or the patient has dementia and cannot manage their own daily medications).
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.
We have reviewed the literature and safety profile of fentanyl transdermal. While the drug is absorbed relatively slowly, it reaches peak levels equivalent to intravenous use and is metabolized and excreted slowly. The pharmacokinetics of fentanyl transdermal demonstrates systemic availability that is equivalent to injectable routes. See WAC 296-20-03014(2).