State Coverage Information


Below is a list of the major health plans in your state along with the authorization forms that may be required when prescribing an opioid.

BELBUCA is Preferred
on top health plans and pharmacy benefit managers, which means
lowest branded co-pays.1

Quick Links:

Links to prior authorization and medical exception forms provided are intended merely as a convenience. None of the forms are generated by Collegium Pharmaceutical, Inc., and Collegium disclaims all responsibility for their content. While we make diligent efforts to ensure links open current versions of each payer’s form, we cannot and do not warrant that each form remains in use, or is the version of the form currently required by the payer, on the date you access it.