1. MaineHealth IMAT ECHO TOPIC: Buprenorphine Formulations
Date: December 21, 2018
Sarah Ambrose, PharmD, BCACP

2. Objectives List the buprenorphine formulations currently available
Describe the REMS program requirements for Sublocade and Probuphine
Develop affordable buprenorphine therapy plan options based on patient-specific insurance or financial resources
(Note: case presentations and Maine-specific coverage information not included in this version of the PowerPoint.) .

3. Buprenorphine Formulations
Buprenorphine + Naloxone
Sublingual Tablets (generic, Zubsolv®)
Sublingual Film (Suboxone®, Cassipa®)
Buccal Film (Bunavail®)
Buprenorphine
Sublingual Tablets (generic)
Extended Release Solution for Injection (Sublocade®)
Implant (Probuphine®)
All REMS –waiver required. Extra REMs for ER inj and Implant

4. Buprenorphine + Naloxone Sublingual Tablets
Buprenorphine + Naloxone (generic)
Generic (least expensive)
Lemon flavor
Zubsolv®
Brand Only
Better Bioavailability (lower doses, smaller tablets)
Larger dosing range
Menthol flavor, better “mouthfeel”
Faster absorption
Free trial offer (up to 30 free tabs)
Copay card (up to $225/rx, no tab min, no limit to monthly uses)
Buprenorphine HCl/Naloxone HCl Sublingual Tablets [prescribing information]. Eatontown, NJ: West-Ward; December 2018
Zubsolv (buprenorphine and naloxone) [prescribing information]. Morristown, NJ: Orexo US; December 2018

5. Buprenorphine + Naloxone SL Tabs: Doses and Pricing
* As of , CVS lowest for generic Tabs, Hannaford lowest all other formulations

6. Conversion Suboxone to Zubsolv®

7. Buprenorphine + Naloxone Sublingual Films
Suboxone Film®
Lime flavor
Absorb faster than generic SL tabs
?lower risk of diversion?
Copay card:
With insurance-$75 off/month
Without insurance-
$0.96 off/2mg film, $1.92 off/ 4mg or 8mg film, $3.84 off/12mg film.
Min 7 film/fill, max 4 fills/mo
Cassipa®
Approved Sept 2018
Buprenorphine 16mg/Naloxone 4mg
Lemon-lime flavor
Not yet available
Likely $$$
Suboxone sublingual film (buprenorphine/naloxone) [prescribing information]. Richmond, VA: Indivior; December 2018
Cassipa (buprenorphine/naloxone) [prescribing information]. North Wales, PA: Teva Pharmaceuticals USA Inc; December 2018

8. Buprenorphine + Naloxone SL Films: Doses and Pricing
*As of , CVS lowest for generic Tabs, Hannaford lowest all other formulations *** Approved Sept 2018, not yet available

9. Buprenorphine + Naloxone Buccal Films
Bunavail Film®
Buccal absorption
BioErodible MucoAdhesive (BEMA®) backing layer to direct delivery
Place the side with text (BN2, BN4, or BN6) next to cheek
Citrus Flavor
Lower incidence of constipation?
Savings Card:
Insured patients: $50 off/14 ds, $100 off/mo
Cash patients: Up to $270 off/mo ($ based on dose)
Bunavail (buprenorphine and naloxone) [prescribing information]. Raleigh, NC: BioDelivery Sciences International Inc; December

10. Conversion Suboxone to Buavail®
* As of , CVS lowest for generic Tabs, Hannaford lowest all other formulations

11. Buprenorphine Sublingual Tablets
Buprenorphine (generic, previously Subutex)
Buprenorphine only
Formulation of choice during pregnancy  But recent studies suggest Suboxone safe
Increased risk of diversion higher abuse potential
Reserve for use with true naloxone allergy
* As of , CVS lowest for generic Tabs, Hannaford lowest all other formulations
Dooley, J et al. Can Fam Physician. Buprenorphine-naloxone use in pregnancy for treatment of opioid dependence 2016 Apr; 62(4): e194–e200.
Buprenorphine sublingual tablets [prescribing information]. Morgantown, WV: Mylan; December 2018

12. Buprenorphine Extended Release Injection
Sublocade® ER SC Sol (300mg/1.5ml, 100mg/0.5ml)
Monthly Subcutaneous Injection (abdominal only by healthcare professional per REMS)
300mg monthly x2 months, then 100mg monthly (add transmucosal dose x2 mo prn)
Must induct patient and adjusted dose using mucosal products for 7 day minimum prior
Separate REMS Program
Both healthcare setting and Pharmacy require special cert.
Specialty Med (either Buy-and-Bill or Direct from Specialty Pharmacy)
Use “INSUPPORT” to review access and reimbursement information
Refrigeration storage required
Copay Assistance ONLY available for patients with Commercial Insurance
Pre-filled syringe
Insupport is the
Sublocade (buprenorphine extended-release) [prescribing information]. North Chesterfield, VA: Indivior Inc; December 2018.

13. Buprenorphine Subdermal Implant
Probuphine® 74.2mg Implant
Patient on MAX 8mg/day Suboxone or Subutex (maintenance phase only)
4 subdermal implants
Inserted into inner side of one upper arm under general anesthesia
Removed and replace in other arm after 6 months
Max of one insertion into each arm (1 year total treatment), then d/c implants and return to mucosal
Separate REMS Program to prescribe and insert/remove (annual re-cert)
Provider must complete live training and demonstrate procedural competency
Attest to performing surgical procedure in last 3 months
Complete multiple other forms
Specialty Med– Only available from Avella Specialty Pharmacy
Probuphine (buprenorphine) [prescribing information]. Princeton, NJ: Braeburn Pharmaceuticals Inc; December 2018.

14. Questions?
Sarah Ambrose, PharmD, BCACP Southern Maine HealthCare