Starting Feb. 1, prior authorization required for high opioid dosages

Blue Cross Blue Shield of Michigan and Blue Care Network remain committed to battling our country’s opioid crisis through various programs and initiatives. Starting Feb. 1, 2019, Blue Cross and BCN will require prior authorization the first time a member’s opioid dosage exceeds 90 morphine milligram equivalents per day. This change affects commercial members only and doesn’t apply to members with an oncology diagnosis or terminal illness, or those with Medicare plans.

The following are opioids commonly prescribed at 90 morphine milligram equivalents per day:

• 90 mg of hydrocodone (nine tablets of hydrocodone/acetaminophen 10/325 mg)
  
• 60 mg of oxycodone (two tablets of oxycodone extended-release 30 mg)

We’ll continue to ensure that our members receive high-quality care for pain, while reducing potential risks that come from such treatments. Higher opioid dosages haven’t been shown to reduce long-term pain and are associated with a higher risk of overdose and death. Dosages at or above 100 morphine milligram equivalents per day are associated with a nearly nine-fold increase in overdose risk compared to dosages of 20 morphine milligram equivalents per day or less.

To help reduce the risk of overdose, we encourage providers to review their patients’ total daily dose of opioids. This helps to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, a naloxone prescription or other measures.
The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention offer some free resources:

• The CMS morphine equivalent chart is available here.**
• The CDC’s new Opioid Guideline app** includes its Guideline for Prescribing Opioids for Chronic Pain, tools and other resources, including a morphine milligram equivalent calculator.

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.