OPIATE DEPENDENCE TREATMENTS | Vendor Drug Program

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BUNAVAIL 2.1-0.3 MG FILM buprenorphine HCl/naloxone HCl	59385001230 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUNAVAIL 2.1-0.3 MG FILM buprenorphine HCl/naloxone HCl	59385001201 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUNAVAIL 4.2-0.7 MG FILM buprenorphine HCl/naloxone HCl	59385001401 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUNAVAIL 4.2-0.7 MG FILM buprenorphine HCl/naloxone HCl	59385001430 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUNAVAIL 6.3-1 MG FILM buprenorphine HCl/naloxone HCl	59385001601 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUNAVAIL 6.3-1 MG FILM buprenorphine HCl/naloxone HCl	59385001630 BIODELIVERY SCI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	62756045983 SUN PHARMACEUTI	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	50383092493 HI-TECH/AKORN C	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	60687048111 AHP	Yes	No	Medicaid CHIP CSHCN HTWPlus
BUPRENORPHINE 2 MG TABLET SL buprenorphine HCl	00904715404 MAJOR PHARMACEU	Yes	No	Medicaid CHIP CSHCN