How to Help Your Patients Find Exparel in Stock: A Provider's Guide

Your patient is scheduled for a total knee replacement and you believe Exparel (bupivacaine liposome injectable suspension) would be the best choice for postoperative pain management. But somewhere between the clinical decision and the operating room, access breaks down — the formulary committee restricted it last quarter, the insurance requires prior auth, or the ASC your patient chose doesn't carry it.

As the prescribing surgeon, anesthesiologist, or CRNA, you play the central role in making Exparel accessible to your patients. This guide provides a practical, step-by-step framework for navigating the barriers and advocating effectively for your patients' pain management needs.

Step 1: Know Your Facility's Formulary Status

The first step is simply knowing whether Exparel is on formulary at the facility where your patient will have surgery — and for which procedure types. Many health systems have procedure-specific formulary restrictions: Exparel may be approved for total joint replacement but not for laparoscopic colectomy, or for shoulder nerve blocks but not for wound infiltration in hernia cases.

Contact your hospital or ASC pharmacy department and ask for the current Exparel formulary status by procedure type. This information should be readily accessible. If your patient is using a different facility (e.g., switching from a hospital to an ASC for cost reasons), verify the formulary at that specific location before the case is booked.

Step 2: Advocate for Formulary Inclusion

If Exparel is not on formulary for your procedure, or has been restricted or removed, you can advocate for its inclusion through your facility's Pharmacy and Therapeutics (P&T) committee. Effective arguments for P&T review include:

• The NOPAIN Act reimbursement: For Medicare patients in outpatient settings, the NOPAIN Act (effective January 2025) authorizes a separate CMS add-on payment for Exparel, which fundamentally changes the cost-benefit calculation for hospital outpatient departments and ASCs.
• Hospital length-of-stay data: Multiple institutional studies have found that Exparel use in procedures like colorectal surgery and total knee arthroplasty can reduce hospital length of stay, which more than offsets the drug's acquisition cost.
• Opioid use reduction: Exparel's role in reducing opioid consumption aligns with institutional ERAS goals and Joint Commission pain management standards, as well as broader public health goals around opioid stewardship.
• Specific high-risk patient populations: Patients with history of opioid use disorder, respiratory compromise (OSA, COPD), or high procedural pain risk may benefit disproportionately from 72-hour non-opioid analgesia.

Step 3: Navigate Prior Authorization for Commercial Insurance

For commercially insured patients, Exparel is typically billed through the medical benefit rather than the pharmacy benefit. Coverage decisions often depend on the specific CPT procedure code being billed. Some common scenarios:

• Major orthopedic procedures (total joint replacement, shoulder surgery): Most large commercial insurers cover Exparel with or without PA.
• Colorectal and general surgery: Coverage is more variable; PA is often required.
• Nerve blocks beyond interscalene: May be considered off-label for non-approved indications, increasing denial risk.

Your facility's pre-authorization team should work with Pacira's PaciraConnect hub, which provides reimbursement support services including PA assistance and appeals support. Pacira's customer service line (1-855-RX-EXPAREL) can also provide current billing and coverage guidance.

Step 4: Prepare Patients for Realistic Expectations

If patients have read about Exparel online and are expecting it, have an honest preoperative conversation. Make clear that Exparel is one element of a comprehensive pain management plan — not a complete solution. Patients should understand:

• Exparel provides analgesia for up to 72 hours from a single injection but does not eliminate all pain.
• Other analgesics (acetaminophen, NSAIDs, possibly opioids for breakthrough) will still be part of their regimen.
• If Exparel is not available, equivalent or near-equivalent pain control is achievable through other methods.

Step 5: Help Patients Find Discharge Prescriptions

Even when Exparel is successfully administered, your patients will leave the hospital or ASC with oral prescriptions for continued pain management. Ensuring those prescriptions are accessible is part of a complete care plan.

medfinder for providers is a paid service that calls pharmacies on your patients' behalf to locate in-stock medications near them. The service texts results directly to the patient — a practical tool that your discharge planning team can recommend to patients who need help locating post-surgical prescriptions quickly after leaving your facility.

See also: Exparel Access Issues: What Providers and Prescribers Need to Know in 2026 for a broader overview of the access landscape.