Methadone tablets (e.g., Diskets®, Dolophine®, Methadose™, generic) — Cigna
Opioid addiction (dependence)
Initial criteria
- Approve for 1 year if ONE of the following (A or B) is met:
- A) Methadone is dispensed by an opioid treatment program certified by the Substance Abuse and Mental Health Services Administration and approved by the designated state authority; OR
- B) Methadone is being prescribed during an emergency period of ≤ 3 days while definitive care for the addiction is being sought in an appropriately licensed facility.
Approval duration
1 year