Quartz is committed to reducing the inappropriate use of prescription opioids.

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