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New Quality and Safety Measures in Opioid Management, Effective July 1, 2012

Prescription opioid addiction and abuse is a growing public health issue in Massachusetts and nationwide. In 2009, the Center for Disease Control reported in a one-month period, 9 million people used opioids for medical purposes. In addition, 5.3 million people used them for non-medical purposes, with the vast majority obtaining them from friends, relatives and doctor prescriptions. Prescription opioids are the number one cause of unintentional overdoses, surpassing cocaine and heroin.

Because of this growing public health problem, we have consulted with an external advisory group of pain management experts, addiction experts, and primary care providers and pharmacists to develop a comprehensive program to promote evidence-based, safe, high quality, opioid prescribing. We anticipate that this program will provide our members with affordable, accessible, and appropriate pain care, while reducing the risk of member addiction and the unauthorized transfer of opioid prescriptions.

Effective July 1, 2012, we will introduce this comprehensive opioid management program that encourages providers to work with their patients in the following ways:

  • Quality opioid management, as further described in the chart below
  • A treatment plan with exploration of alternative therapies
  • Member informed consent regarding the risk and benefits of opioids
  • Behavioral contract to ensure appropriate access to opioids
  • One prescriber group and pharmacy chain
  • The appropriate use of urine drug testing

Effective July 1, 2012, the following policies will be effective to support the strategy described above.

Medication or Class Policy
Opioids with Acetaminophen Based on FDA guidance, opioid prescriptions containing acetaminophen will be limited to up to 4 grams of acetaminophen per day. Prescriptions exceeding 4 grams per day will be reduced at the point of sale.

This applies to both new and existing prescriptions.
Opioids Opioids prescriptions will only be available at retail pharmacies. Opioids will no longer be available at the mail service pharmacy.

This applies to both new and existing prescriptions.
Short-acting opioids Coverage limited to 15-day supply for initial prescription. Coverage available for an additional 15-day supply within 60 days of the initial fill. Authorization required for subsequent prescriptions. If an authorization is not obtained at the point of sale, the member will be provided with a 3-day supply of the opioid. This will provide time for an authorization to be obtained.

This applies to new prescriptions. A new prescription is a prescription for a medication that has not been filled within the past 60 days.
New long-acting opioid prescriptions Prior authorization required. If an authorization is not obtained at the point of sale, the member will be provided with a 3-day supply of the opioid. This will provide time for an authorization to be obtained.

This applies to new prescriptions. A new prescription is a prescription for a medication that has not been filled within the past 60 days.
Suboxone & buphenorphine Prior Authorization required

This applies to both new and existing prescriptions, however, the requirement for existing prescriptions will be effective on 10/15/2012.

Policy guidelines include provisions for our members being treated for cancer and end of life care so that we do not disrupt their care. This change applies to all commercial products, Managed Blue for SeniorsSM, and Medex®' plans with a pharmacy benefit.

Blue Cross Blue Shield of Massachusetts

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