Lazanda (fentanyl nasal spray) — Cigna

Preferred products

• fentanyl citrate oral transmucosal lozenge (Actiq, generics)
• Abstral
• Fentora
• Subsys

Initial criteria

• A) Individual meets ONE of the following conditions (i or ii): i. Individual is unable to swallow, has dysphagia, esophagitis, mucositis, or uncontrollable nausea/vomiting; OR ii. Individual is unable to take two other short-acting narcotics secondary to allergy or severe adverse events; AND
• B) Individual is on or will be on an oral or transdermal long-acting narcotic, or the individual is on intravenous, subcutaneous, or spinal (intrathecal, epidural) narcotics; AND
• C) Individual meets ONE of the following conditions (i, ii, or iii): i. The individual has tried two of the following, if two are formulary (or one if only one is formulary or none if none are formulary): fentanyl citrate oral transmucosal lozenge (Actiq, generics), Abstral, Fentora, Subsys [verification of therapies required]; OR ii. In individuals who cannot tolerate the sugar content of fentanyl citrate oral transmucosal lozenge (Actiq, generics) [e.g., individuals who are glucose intolerant, diabetic, at high risk of dental caries], the individual has tried two of the following, if two are formulary (or one if only one is formulary or none if none are formulary): Abstral, Fentora, or Subsys [verification of therapies required]; OR iii. The individual has cancer and mucositis.

Approval duration

1 year