Request for Prior Authorization - Opioid with Concurrent Buprenorphine/Naloxone or Buprenorphine
Customize your policy alerts
Sign up for all Blue Cross Blue Shield - Nevada policy alerts
Know when Blue Cross Blue Shield - Nevada releases new policies or updates existing guidance.
Monitor payer policy activity
Form and instructions governing prior authorization requests when prescribing an opioid concurrently with buprenorphine/naloxone or buprenorphine for members served by Anthem Blue Cross and Blue Shield programs listed; applies to prescribing providers completing the PA form.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage criteria for concurrent opioid use
Covered when ALL of the following are met:
If opioid therapy is expected to exceed seven days, provide a brief explanation including expected duration and a taper/discontinuation plan.
Coding Information
| No codes listed |
Provider Actions and Submission Instructions
Submission instructions and retroactive PA
Complete the prior authorization form in its entirety and fax to the Prior Authorization of Benefits Center at 844-864-7860 for retail submissions or 888-209-7838 for medical injectable submissions. Mark the box on the form if requesting a retroactive prior authorization and provide the dates of service when applicable; submit retroactive requests with dates of service prior to 30 calendar days of submission separately from current PA requests.
- Retail fax: 844-864-7860
- Medical injectable fax: 888-209-7838
- If requesting retroactive PA, mark the box and list date(s) of service
- Submit retroactive DOS prior to 30 calendar days separately from current requests
Concurrent therapy approval and justification
Confirm the prescriber of buprenorphine/naloxone or buprenorphine has been notified and approves the use of the prescribed opioid therapy, and indicate the buprenorphine prescriber's name on the form. If opioid therapy is expected to continue concomitantly for greater than seven days, provide a brief explanation including expected duration and a taper/discontinuation plan.
- Document prescriber's name approving concurrent therapy
- Provide explanation and taper plan if therapy > 7 days
Form completion requirement
All sections of the PA form must be completed by the prescribing provider; incomplete forms will be returned.
- Form must be completed by the prescribing provider
- All sections required — requests with missing information will be returned
Definitions
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.