Non-formulary opioid analgesics — Point32Health
end-of-life 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