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Advanced Opioid Management Program Updates

Audience: Participating Providers

The Advanced Opioid Management Program has successfully reduced the risk of opioid abuse and misuse in the community since implementation on July 1, 2018. This program, in combination with provider vigilance of opioid prescribing has:

  • Reduced the average day supply per claim for the first fill for short acting opioids by over 50%.
  • About 50% of patients prescribed a long-acting opioid as initial therapy were redirected to safer, short-acting alternatives.

In an effort to continue to control and decrease the risk of opioid abuse, Excellus BlueCross BlueShield has partnered with our pharmacy benefit manager to implement some additions to the existing Advanced Opioid Management Program. These changes will be effective April 1, 2020.

Enhancements to the program include:

  1. Short-acting opioids:
    1. For members 18 years of age and older:
      • All new prescriptions for short-acting opioids in an opioid-naïve patient will reject if written for a quantity that exceeds a 7-day supply. This rejection will apply to the first four (4) fills of a short acting opioid for an opioid-naïve patient.
    2. For members younger than 18 years of age:
    • All new prescriptions for short-acting opioids in an opioid-naïve patient will reject if written for a quantity that exceeds a 3-day supply. This rejection will apply to the first four (4) fills of a short acting opioid for an opioid-naïve patient.

 

  1. Morphine equivalent dose:
    1. New starts to opioid therapy:

§ Cumulative opioid maximum daily dose that exceeds 90mg (between 91 and 200) morphine milligram equivalent (MME) will reject for a safety review.

    1. Existing members on opioid therapy:

§ Cumulative opioid maximum daily dose that exceeds 200mg morphine milligram equivalent (MME) will reject for a safety review.

 
 
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