FormWeb • buprenorphine

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Ochsner Health System Formulary

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Medications listed are available on OH EPIC Formulary, unless otherwise noted.
Not all formulary medications are available at each facility. Please refer to your local pharmacy for available inventory.

Ochsner Health

Ochsner Health System Formulary

Formulary Addition Request Questions or Suggestions?

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buprenorphine

buprenorphine

Drug Name	Form	Strength
Belbuca	FILM, BUCCAL	150 mcg; 450 mcg; 900 mcg
Butrans	FILM, EXTENDED RELEASE, TRANSDERMAL	5 mcg/hr
Brixadi Weekly	SOLUTION, EXTENDED RELEASE, SUBCUTANEOUS	8 mg/0.16 mL; 16 mg/0.32 mL; 24 mg/0.48 mL; 32 mg/0.64 mL;
Brixadi Monthly	SOLUTION, EXTENDED RELEASE, SUBCUTANEOUS	32 mg/0.64 mL; 96 mg/0.27 mL
Sublocade	SOLUTION, EXTENDED RELEASE, SUBCUTANEOUS	100 mg/0.5 mL
Brixadi Monthly	SOLUTION, EXTENDED RELEASE, SUBCUTANEOUS	128 mg/0.36 mL
Sublocade	SOLUTION, EXTENDED RELEASE, SUBCUTANEOUS	300 mg/1.5 mL
Buprenex	SOLUTION, INJECTABLE	0.3 mg/mL
Buprenorphine HYDROCHLORIDE	TABLET, SUBLINGUAL	2 mg; 8 mg

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Belbuca (buprenorphine) buccal film OH Epic Formulary with restrictions:

Indication: microdosing strategy for opioid use disorder or opioid dependence
Service Line: all providers
Formulary Location: Inpatient
Service location: Inpatient
Patient Population: Adults
Prior Authorization Required: no

Brixadi (buprenorphine) extended release subcutaneous injection OH Epic Formulary with restrictions:

Indication: For the treatment of moderate to severe opioid use disorder in patients who have initiated treatment with a single dose of a transmucosal buprenorphine product or who are already being treated with buprenorphine.
Service line: All providers
Formulary location: Outpatient
Service location: Clinic
Patient population: Adults (age ≥ 18 years)
Prior authorization required: Yes
Restriction/criteria of use (all will apply unless specified):
- Diagnosis of opioid dependence
- Patient meets one of the following:
  - Patient is switching from another non-transmucosal buprenorphine-containing product (e.g., Sublocade)
  - Patient has tolerated a single 4 mg dose of transmucosal buprenorphine-containing product OR currently is being treated with a transmucosal buprenorphine-containing product
- Medical justification supports inability to continue to use transmucosal (e.g., sublingual, buccal) formulations of buprenorphine as evidenced by one of the following:
  - Documentation of non-compliance to transmucosal formulations of buprenorphine
  - Treatment failure with transmucosal formulations of buprenorphine
  - History of diversion with buprenorphine medication-assisted treatment (MAT) products
  - Contraindication(s) or clinically significant adverse effects to the excipients of transmucosal formulations of buprenorphine
- Healthcare settings and pharmacies that order and dispense buprenorphine (Brixadi) must be certified and comply with the buprenorphine (Brixadi) REMS requirements

Last updated: Jul. 11, 2025

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