Varies by drug product
Coverage of drugs is first determined by the member’s pharmacy or medical benefit. Please consult with or refer to the Evidence of Coverage document.
AND
Drug | Dosing Regimen | Dose Limit/ Maximum Dose |
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Drug | Dosing Regimen | Authorization Limit |
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Various narcotics | Various | Cancer Pain Length of Benefit End-stage medical conditions accompanied by significant pain Length of Benefit LTC Facility Resident Length of Benefit All other diagnoses 6 months initially for non-malignant pain. Duration of re-authorization may be for up to one year upon submitting written documentation of a current treatment plan. |