Opioid Risk Management Program

Excessive use of opioids can lead to addiction, overdose, and death. New restrictions will be in place effective August 1, 2018 for Quartz (fully-insured) commercial members.

These restrictions will limit:

• The number of days’ supply that can be filled for opioid naïve members (7 days or less)
• The dose of opioids members can receive (cumulative daily dose of 120 morphine milligram equivalents (MME) will require an approved Prior Authorization (PA))* ‡
• The use of opioids in combination with other medications that may be inappropriate

* In order to avoid interruptions in therapy, members who are currently using opioids at a dose >120 MME can continue filling their opioids until 12/1/2018.

This provides current utilizers time to obtain a prior authorization to continue therapy. Current members who are identified as needing to complete a Prior Authorization will be notified of this new requirement.

‡ Prior Authorization criteria is as follows:

ONE of the following conditions applies:

• cancer-related pain, hospice, palliative, end-of-life, or long term care (LTC) residence.

OR ALL of the following apply:

• Prescriber statement indicating the dose being prescribed is medically necessary AND
• The PDMP has been checked in the past month AND
• Pain contract is in place AND
• Prescription for naloxone (example: Narcan nasal spray) sent to the pharmacy AND
• Urine compliance screen in previous 12 months