New Coverage Requirements for Short-Acting Opioids
Effective October 1, Florida Blue updated its Responsible Rx Utilization Management programs to include short-acting opioid medications, such as oxycodone, hydrocodone and others.
As part of Florida Blue’s commitment to address the opioid crisis in the United States and in Florida, we introduced prior authorization and supply limits for use of short-acting opioids. These changes have been made to help ensure the appropriate use of opioid pain medication for members suffering from chronic pain. This also is designed to protect both members and their families from the risk of opioid abuse, misuse and diversion, while providing continued access to opioid medications when appropriate.
The new Responsible Rx guidelines are in addition to the recent changes that Florida Blue made to coverage of OxyContin (below update dated Sept 21).
New Supply Limit and Prior Authorization Changes:
Effective October 1, 2017, Florida Blue now requires a seven day limit for short-acting (immediate release) opioids for new prescriptions.
- Use of short-acting opioids beyond the seven-day limit will require prior authorization.
- The 7-day limit only affects new opioid users. Members on a stable, ongoing, short-acting opioid treatment plan are not impacted.
- Prior authorization criteria allows for extended use (beyond seven days) of short-acting opioids in the following situations:
- Chronic cancer pain*
- Hospice care*
- Chronic non-cancer pain*
Recently Prime Therapeutics LLC (Prime) a pharmacy benefit manager (PBM) and Walgreens have formed a
combined central specialty pharmacy and mail services company, as part of a strategic alliance first announced
by the companies last August
We are actively working to unite mail services and central specialty operations.
As part of that effort we will be upgrading our pharmacy systems. While this is happening, rest assured that you
will continue to receive the same care and support you expect from Prime Therapeutics Specialty Pharmacy
(Prime Specialty Pharmacy).
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