Fentora (fentanyl buccal tablet – Teva, authorized generic) — Cigna

Preferred products

• fentanyl citrate oral transmucosal lozenge (Actiq, generic)

Initial criteria

• Patient meets ONE of the following conditions (i or ii): i. Patient is unable to swallow, has dysphagia, esophagitis, mucositis, or uncontrollable nausea/vomiting; OR ii. Patient is unable to take two other short-acting narcotics secondary to allergy or severe adverse events
• Patient is on or will be on an oral or transdermal long-acting narcotic, or the patient is on intravenous, subcutaneous, or spinal (intrathecal, epidural) narcotics
• Patient meets ONE of the following conditions (i or ii): i. The patient has tried fentanyl citrate oral transmucosal lozenge (Actiq, generic) [verification of therapies required]; OR ii. Patient cannot tolerate the sugar content of fentanyl citrate oral transmucosal lozenge (Actiq, generic)

Approval duration

6 months