Actiq — Blue Cross Blue Shield of Alabama

Initial criteria

• - The patient has a diagnosis of chronic cancer pain due to active malignancy
• - The patient's age is within FDA labeling for the requested agent OR there is support for use of the agent for the patient’s age for the requested indication
• - The patient is opioid tolerant (taking, for ≥1 week, around‑the‑clock opioid therapy equal to at least 60 mg oral morphine per day, 25 mcg/hr transdermal fentanyl, 30 mg oral oxycodone per day, 8 mg oral hydromorphone per day, 25 mg oral oxymorphone per day, 60 mg oral hydrocodone per day, or an equianalgesic dose)
• - The patient is taking a long‑acting opioid concurrently with the requested TIRF agent
• - The patient will NOT use the requested agent in combination with any other TIRF agent in any other strength
• - The request is for a generic TIRF agent OR (for a brand TIRF agent) ONE of: use of at least one generic TIRF agent within past 90 days; current treatment with the requested agent within past 90 days; prescriber states patient currently treated within past 90 days and at risk if therapy changed; intolerance/hypersensitivity to at least one generic TIRF agent; FDA labeled contraindication to all generic agents not expected with requested agent
• - The patient does NOT have any FDA labeled contraindications to the requested agent

Reauthorization criteria

• Reauthorization follows same criteria as initial approval; continuation allowed if patient continues to meet all requirements including opioid tolerance, concurrent long‑acting opioid use, and absence of contraindications.

Approval duration

1 month (dose titration) or 6 months (other requests)