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PRIOR AUTHORIZATION REQUEST FORM BM CHP 9.107 Opioids 2 buccal lozenge Version 19.0 Effective Date 1/1/17 Phone: 8885660008 Fax back to: 8663055739 ENVISION RX OPTIONS manages the pharmacy drug benefit

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How to fill out buccal lozenge

01

Step 1: Wash your hands thoroughly before handling the buccal lozenge.

02

Step 2: Take out one lozenge from the packaging.

03

Step 3: Place the lozenge in your mouth between your cheek and gum.

04

Step 4: Allow the lozenge to dissolve slowly without chewing or swallowing it.

05

Step 5: Avoid eating or drinking anything for at least 30 minutes after using the buccal lozenge.

Who needs buccal lozenge?

01

Buccal lozenges are typically recommended for individuals who need local or systemic drug delivery through the buccal mucosa.

02

They may be prescribed for patients with conditions such as oral infections, mouth ulcers, or as a form of hormone replacement therapy.

03

Consult with a healthcare professional to determine if buccal lozenges are suitable for your specific needs.

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What is buccal lozenge?

Buccal lozenge is a medicated tablet or lozenge that is dissolved slowly in the mouth between the cheek and gum.

Who is required to file buccal lozenge?

Only individuals who have been prescribed buccal lozenges by their healthcare provider are required to file buccal lozenge.

How to fill out buccal lozenge?

To fill out a buccal lozenge, follow the instructions provided by your healthcare provider. It typically involves placing the lozenge in your mouth and allowing it to dissolve slowly.

What is the purpose of buccal lozenge?

The purpose of buccal lozenge is to deliver medication directly into the bloodstream through the mucous membranes in the mouth.

What information must be reported on buccal lozenge?

Information such as the name of the medication, dosage, frequency of use, and any side effects experienced must be reported on the buccal lozenge.

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