Dear Pharmacist and/or Support Staff,

In March of 2016, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain. The summary of evidence demonstrates that the risk of opioid use greatly outweighs the benefit for the majority of patients. Their in-depth review echoed conclusions drawn by many other organizations – the benefit gained from the long-term use of opioids for chronic, non-cancer pain, does not outweigh the associated risks of using the medication. Population studies of death rates and prescribing practices demonstrate a close relationship between the amount of opioids prescribed and deaths related to their use. In short, there is inadequate evidence to support long-term opioid use for chronic, non-cancer pain.

In an effort to support and promote safe opioid use and appropriate pain management, InterCommunity Health Network Coordinated Care Organization (IHN-CCO) is implementing new authorization criteria, using evidence-based best practices that have been supported by our regional task force, now called PainWise, and state organizations.

Key highlights of the authorization criteria changes are as follows:

• Chronic opioid coverage is initially limited to 120 morphine equivalent dose (MED) per day or less for members with funded conditions. Further MED reduction requirements may occur in the future.  Tapering plans are required and must be submitted by patient’s provider to IHN-CCO.
• Tapering assistance is available from IHN-CCO pharmacy clinical staff.

Opiate benefit changes will begin February 1, 2017:

Providers were notified in writing and will have until January 15, 2017, to respond with a tapering plan. If no tapering plan is received, IHN-CCO will proceed with denial of opioid benefits. OHA has determined that coverage of opioids for back pain and related diagnoses will be terminated on 1/1/2018, therefore tapering of opioids should occur during 2017.

A letter has been mailed to IHN-CCO members in an effort to make them aware of the upcoming changes and provide them with a better understanding of the reasons behind the new prescribing limits.

It is vital that you and your staff are aware and can communicate these changes to your patients. If you have any questions or would like more information, please call IHN-CCO Customer Service at (888) 435-2396 or (541) 768-5207 or TTY (800) 735-2900, Monday through Friday 8 a.m. to 8 p.m.

Sincerely,

IHN-CCO Pharmacy Department