Lucemyra (lofexidine) — Point32Health
mitigation of opioid withdrawal symptoms to facilitate abrupt opioid discontinuation in adults
Preferred products
- Clonidine tablet
- Clonidine ER tablet
Initial criteria
- The patient has had a trial of a Step-1 or Step-2 medication within the previous 180 days as evidenced by a paid claim under the prescription benefit administered by the plan
- OR The patient has had a trial of a Step-1 or Step-2 medication as evidenced by physician documented use, excluding the use of samples
- OR The requesting physician has documented that the patient has a contraindication to or intolerance to all Step-1 medications
Approval duration
1 month