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oxycodone/acetaminophen — CareFirst (Caremark)

Acute pain severe enough to require an opioid analgesic

Initial criteria

  • For pain associated with cancer, sickle cell disease, a terminal condition, or pain being managed through hospice or palliative care: Authorization may be granted when the requested drug is being prescribed for these conditions.
  • For acute pain: Authorization may be granted when the patient requires treatment for acute pain severe enough to require an opioid analgesic AND ALL of the following are met:
  • • The patient can safely take the requested dose based on their history of opioid use.
  • • The patient has been evaluated and will be monitored regularly for the development of opioid use disorder.
  • For chronic pain: Authorization may be granted when the requested drug is being prescribed for chronic pain severe enough to require an opioid analgesic AND ALL of the following are met.