November 2023

We’ve updated how we calculate MME measurements for certain opioids

Blue Cross Blue Shield of Michigan and Blue Care Network have updated how we calculate morphine milligram equivalents, or MME, measurements for certain opioids. The update, based on changes recommended by the Centers for Disease Control and Prevention, was effective Oct. 1.

MMEs are calculations used to measure and compare different opioids, using morphine as the standard. Blue Cross requires a prior authorization for opioid dosages that exceed 90 MMEs per day. This change will only affect the opioids listed in the table below:

Medication	Current MME conversion factor	New MME conversion factor
Hydromorphone	4	5
Methadone	Sliding scale dependent on dose	4.7
Tramadol	0.1	0.2

Members who fill hydromorphone, methadone or tramadol prescriptions may experience a claim rejection when their total daily MME exceeds the plan threshold level of 90 MME, even if the member hasn’t changed doses. The total MME of all opioids remains at 90 MME per day and won’t change.

If the pharmacy receives a rejected claim due to this change, the provider will need to submit a prior authorization request attesting that the dose is medically necessary. If we don’t provide a prior authorization, members may not be able to fill the prescribed dose.

For more information related to this change, refer to the Opioid National Drug Code and Oral MME Conversion File Update** on the CDC website.

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

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved.