Non-formulary opioid analgesic medications — Point32Health

Sickle-cell pain

Initial criteria

Patient diagnosed with sickle-cell, cancer-related, or end-of-life pain OR patient has a diagnosis of pain
Patient signed a pain agreement consistent with the American Academy of Pain Management guidelines
Patient tried and failed a generic short-acting opioid if the request is for a long-acting opioid
Risks of high-dose schedule II, III, or IV analgesic use have been discussed with patient
Provider has a plan to monitor for misuse, abuse, and addiction during therapy

Patient diagnosed with sickle-cell, cancer-related, or end-of-life pain OR patient has a diagnosis of pain
Patient signed a pain agreement consistent with the American Academy of Pain Management guidelines
Risks of high-dose schedule II, III, or IV analgesic use have been discussed with patient
Provider has a plan to monitor for misuse, abuse, and addiction during therapy