7 Day Limit on Initial Therapy with Short-Acting Opioids Beginning 12/1/19
Dear Providers,
Maryland Physicians Care (MPC) is committed to partnering with you to combat the opioid epidemic. To support that, we’re introducing a comprehensive suite of opioid management tools built around prescribing guidelines, prescriber support, and patient education. Each component focuses on your patients’ best interests to promote the safe use of opioid medications and prevent progression to misuse and abuse.
New Prescribing Guidelines
MPCs Opioid Prescribing Guidelines are aligned with FDA product labeling and CDC opioid prescribing guidelines. For patients new to opioids:
- Limit of 7 days’ supply of opioid medications for patients without recent history of opioid use
- Patients may only receive short-acting opioids for initial therapy
- For members requiring greater than 7 days of short-acting opioid medications, prior authorization can be obtained
- Initial approval for 3 months, subsequent approvals are provided for 12 months in duration
Exceptions
The quantity requested for a short-acting may be permitted in patients who meet one of the following criteria (A, B, or C):
A. The patient has a cancer diagnosis; OR
B. The patient is in hospice program, end-of-life care, or palliative care; OR
C. For patients who do not have a cancer diagnosis, approve if the patient meets the following criteria (i, ii, and iii):
a. Non-opioid therapies (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs], acetaminophen) have provided an inadequate response or are inappropriate according to the prescribing physician; AND
b. The patient’s history of controlled substance prescriptions has been checked using the state prescription drug monitoring program (PDMP), unless unavailable in the state, according to the prescribing physician; AND
c. Risks (e.g., addiction, overdose) and realistic benefits of opioid therapy have been discussed with the patient according to the prescribing physician.
If you have any questions about this benefit change, please call your Provider Services department toll-free at 1-800-953-8854.
We appreciate the care you provide our members, and we look forward to working with you to battle this epidemic.
Sincerely,
Pharmacy Department
