Opioid benefit changes

What benefit changes have been made?

Effective Jan. 1, 2016, these changes to opioid medications were made:

  • All strengths of long-acting morphine require prior authorization.
  • All formulary opioids are limited to 120 morphine equivalent dose (MED) daily.

Example of 120 MED

Product

Daily Quantity Limit

Oxycodone HCL Tab 5mg

16 Tablets per day

Oxycodone HCL Tab 10mg/ Percocet 10-325mg

8 Tablets per day

Oxycodone HCL Tab 15mg

5 Tablets per day

Oxycodone HCL Tab 20mg

4 Tablets per day

Oxycodone HCL Tab 30mg

2 Tablets per day

Example of an online MED calculator: www.agencymeddirectors.wa.gov/Files/DosingCalc.xls

Why were these changes made?

To support and promote safe opiate use and appropriate pain management Align with the CDC’s Guidelines for Prescribing Opioids for Chronic Pain, and the recent Oregon Health Authority coverage change for the treatment of back pain The risk of opiate use greatly outweighs the benefit for the majority of patients

What can prescribers do to help?

When writing a prescription for opioid medication, consider including a stated maximum number of tablets per day or a minimum day supply the prescription is intended to last. For example, by writing “…up to X tablets per day” or “...must last X days”, it will ensure the pharmacy to run the claim at the truly expected day supply.

Example:


What other recent changes have been made?

  • Nasal Narcan is now covered.All naloxone products can be refilled once every 6 months (2 dose per fill limit).
  • Expanded non-pharmacological interventions for pain management in response to the recent Oregon Health Authority changes for back pain coverage (Guideline Note 60):

Service

PA Required

Acupuncture

No

Chiropractic Care

Yes

Physical Therapy

Yes

 

 


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