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PRIOR AUTHORIZATION FORM Sublocade Commercial Unless otherwise indicated below, authorization quantities are limited to the manufacturer recommended dosageComplete online at www.selecthealth.org/pa
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How to fill out sublocade will default to
How to fill out sublocade will default to
01
Schedule an appointment with a healthcare provider who is certified to prescribe Sublocade.
02
Complete any necessary paperwork and provide your medical history to the healthcare provider.
03
Discuss your current opioid use and treatment goals with the healthcare provider.
04
Receive a physical examination to determine if you are a suitable candidate for Sublocade.
05
Receive the Sublocade injection at the healthcare provider's office.
06
Follow up with your healthcare provider for any necessary monitoring or adjustments to your treatment plan.
Who needs sublocade will default to?
01
Individuals who are diagnosed with moderate to severe opioid use disorder may be candidates for Sublocade.
02
Sublocade is typically recommended for individuals who have not responded well to other forms of medication-assisted treatment for opioid addiction.
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What is sublocade will default to?
Sublocade will default to a drug delivery system that provides extended-release medication for opioid use disorder.
Who is required to file sublocade will default to?
Healthcare providers authorized to prescribe medication for opioid use disorder are required to file sublocade.
How to fill out sublocade will default to?
To fill out sublocade, providers must complete the necessary documentation outlining patient treatment plans and medication administration.
What is the purpose of sublocade will default to?
The purpose of sublocade is to provide patients with a long-acting treatment option for opioid use disorder, improving adherence and outcomes.
What information must be reported on sublocade will default to?
Providers must report patient demographics, treatment history, and any adverse effects experienced during sublocade treatment.
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