Coverage stance: covered_with_criteria for Journavx (suzetrigine) for Neighborhood Medicaid members. Scope: defines clinical eligibility (including age >=18, documentation of moderate to severe pain, prior trial and failure of at least one generic pain medication within the previous 30 days or documentation that alternatives are inappropriate, or history of opioid use disorder), quantity limits (Journavx 50 mg — 29 tablets per 14-day supply every 6 weeks), coverage duration (6 weeks), and step therapy coding logic (coverage may be allowed if there is at least one paid claim for a buprenorphine product for opioid dependence). Investigational uses or doses/conditions not recognized as medically accepted indications are not covered.