Methadone (all forms) see full law

Vivitrol® (naltrexone ER) injection:• Prior authorization for claims submitted under the pharmacy benefit may be approved when Vivitrol is administered by a healthcare professional in the member’s home or in a long-term care facility. All other Vivitrol claims must be billed through the medical benefit.• Effective 01/01/2019, pharmacies that have entered into a collaborative practice agreement with one or more physicians for administration of Vivitrol may receive reimbursement for enrolled pharmacists to administer Vivitrol with appropriate claim submission through the Health First Colorado medical benefit (claims for pharmacist administration of Vivitrol are not covered under the pharmacy benefit). Additional information regarding pharmacist enrollment and medical claims billing can be found at https://www.colorado.gov/hcpf/otcimmunization. see full law

Zubsolv® (buprenorphine/naloxone) sublingual tablet will be approved if all of the following criteria are met:• Approval will be granted if the prescriber meets the qualification criteria under the Drug Addiction Treatment Act (DATA) of 2000 and has been issued a unique DEA identification number by the DEA, indicating that he or she is qualified under the DATA to prescribe Subutex or Suboxone AND• The member has a diagnosis of opioid dependence AND• The member is 16 years of age or older AND• No claims data show concomitant use of opiates in the preceding 30 days unless the physician attests the member is no longer using opioids AND • The member must have tried and failed, intolerant to, or has a contraindication to generic buprenorphine/naloxone SL tablets or Suboxone films. see full law

Subutex® (buprenorphine) sublingual tablet will be approved if all of the following criteria are met: • The prescriber is authorized to prescribe Subutex AND • The member has an opioid dependency AND • The member is pregnant or the member is allergic to Naloxone AND • Subutex will not be approved for the treatment of pain AND • Subutex will not be approved for more than 24mg/day see full law

Suboxone® (buprenorphine/naloxone) sublingual film will be approved if the all of following criteria are met: • The prescriber is authorized to prescribe Suboxone AND • The member has an opioid dependency AND • The member is not currently receiving an opioid or opioid combination product unless the physician attests the member is no longer using opioids AND • Will not be approved for the treatment of pain AND • Opioid claims will not be allowed for members with a claim for Suboxone in the preceding 30 days AND • Will not be approved for more than 24mg of buprenorphine /day see full law

Sublocade® (buprenorphine extended-release) injection will be approved for members who meet all of the following criteria: • Sublocade is being administered in a long-term care facility or in a member’s home by a home healthcare provider (all other claims must be submitted through the medical benefit) AND • Sublocade is being dispensed directly to the home healthcare professional (medication should not be dispensed directly to the member) AND • Provider attests to member’s enrollment in a complete treatment program including counseling and psychosocial support AND • Member must have documented diagnosis of moderate to severe opioid use disorder AND • Member must have initiated therapy with a transmucosal buprenorphinecontaining product, and had dose adjustment for a minimum of 7 days AND • Maximum dose is 300 mg injection every month see full law

Bunavail® (buprenorphine/naloxone) buccal film will be approved for members who meet all of the following criteria: • Approval will be granted if the prescriber meets the qualification criteria under the Drug Addiction Treatment Act (DATA) of 2000 and has been issued a unique DEA identification number by the DEA, indicating that he or she is qualified under the DATA to prescribe Subutex® or Suboxone® AND • The member has a diagnosis of opioid dependence AND • The member is 16 years of age or older AND • No claims data show concomitant use of opiates in the preceding 30 days unless the physician attests the member is no longer using opioids AND • The member must have tried and failed, intolerant to, or has contraindication to generic buprenorphine/naloxone SL tablets or Suboxone films. see full law