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Non-formulary opioid analgesics — Point32Health

cancer-related pain

Initial criteria

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

Reauthorization criteria

  • Patient is diagnosed with sickle-cell, cancer-related, or end-of-life pain OR all of the following: 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 the patient
  • Provider has a plan to monitor for signs of misuse, abuse, and addiction during therapy