Effective July 1, 2010
Commercial Coverage Change for Subutex®, Buprenorphine and Suboxone®

Effective for fill dates on or after July 1, 2010, Tufts Health Plan will require prior authorization for coverage of the drugs Subutex, its generic buprenorphine, and Suboxone (buprenorphine/naloxone).

Additionally, the following dispensing limitations will apply to Suboxone (buprenorphine/naloxone):

• Suboxone 8mg/2mg: 120 sublingual tablets per 30 days
• Suboxone 2mg/0.5mg: 90 sublingual tablets per 30 days

With the exception of specified coinsurance, copayments or deductibles under the member’s benefit plan, all covered services associated with the management of these medications should be billed to Tufts Health Plan.

Coverage criteria for these and other drugs can be found in Tufts Health Plan’s Pharmacy Medical Necessity Guidelines.

May 1, 2010
Note: The information in this article was correct as of the date of posting and may not reflect subsequent policy changes.