Buprenorphine products

Authorization form 

Products for controlling pain:

Traditional & Optimized (07/2018)

Priority Health Medicare Part D no longer utilize drug-specific prior authorization forms for drugs covered under the pharmacy benefit.

Visit the Approved Drug List (ADL) to search by drug name and view the criteria and PA form.

Go to Medicare ADL

For further information on medical drugs, please see the Injectable drugs page.

Please note that buprenorphine implant (J0570) is not covered for any line of business, however Sublocade (Q9991 and Q9992) may be covered for Commercial or Medicare plans with prior authorization. Please see Sublocade page for more information