Zohydro

Drug - Zohydro (extended-release hydrocodone) [Zogenix]

June 2014

Therapeutic Area - Long-Acting Opioid Analgesics

Approval criteria

Patient has a diagnosis of chronic pain AND
Provider is a physician certified in Pain Management AND
Provider attests that the Prescription Monitoring Program has been reviewed and provides date of review AND
Patient tried morphine ER and found to be intolerant to morphine ER AND
Patient has tried and failed oxycodone ER AND
Patient has tried and failed fentanyl AND
Patient has tried and failed hydromorphone ER AND
Patient has tried and failed oxymorphone ER AND
Provider has submitted a patient specific pain management plan AND
Patient and Provider documented in the pain management plan that the patient will abstain from alcohol

Patient has renal insufficiency
Patient has a true morphine allergy (as manifested by skin rash, facial swelling, or difficulty breathing)
Patient develops morphine-related itching
Patient cannot tolerate the nausea and vomiting of morphine

MHCP Provider Call Center 651-431-2700 or 800-366-5411