Drug Formulary updates for opioid medications include:
1. The first opioid prescription for members will be limited to a 7-day supply, and these members will also be limited to a 14-day supply per episode.
Longer therapy will require prior authorization. Providers will be asked to attest that therapy is being managed per standard opioid prescribing guidelines, including an assessment and documentation of risk factors for chronic opioid use.
2. Opioids will be limited to a cumulative daily dose less than 90 morphine-equivalents. This expands our current daily MED limit to include all opioid prescriptions. Higher doses require prior authorization.
3. Long-Acting Opioids will require prior authorization for members with new prescriptions. Long-acting opioids require a provider attestation, that therapy is being managed per standard opioid prescribing guidelines, including reserving for patients with established opioid tolerance.
4. Codeine and tramadol will be non-formulary for those <= age 11.
5. Opioid cough syrups will be non-formulary for those <= age 17.
These updates start July 2nd, 2018, for Commercial and State Public Programs.
These changes are being made to align with new guidelines and to reduce the risk of opioid addiction.
Pharmacies are asked to:
• Be aware of coverage guidelines.
• Contact HealthPartners if these medications are medically necessary (fax 952-853-8700 or 1-888-883-5434, telephone 952-883-5813 or 1-800-492-7259).
We hope this is helpful to you as you work to deliver safe, effective, and affordable care to your patients.
Please see the attachment for more information on the Opioid Abuse Reduction Program.