New Opioid Script Limits Announced By Blue Cross Michigan

By Paul Gaita 12/12/17

The tighter opioid prescription limits will impact both new and existing prescriptions with refills.

Pharmacist talking to female client

In efforts to address the opioid epidemic in both its state and the nation, Blue Cross Blue Shield of Michigan has announced that it will limit its members' opioid prescriptions to 30 days, and in some cases, five days.

The health care provider arrived at its decision regarding the policy, which will begin on February 1, 2018, after reviewing existing policies within Blue Cross and its HMO network, Blue Care, regarding opioid prescriptions.

Patients will still have access to medication, but depending on the type of opioid prescription, they may have to acquire a new and limited prescription. The move by Blue Cross Blue Shield of Michigan follows similar actions by other insurance networks and pharmacies to cut back on such prescriptions in an attempt to curb the proliferation of opioids fueling the crisis.

According to Blue Cross, the impending policy will impact not only new prescriptions but also any existing prescriptions with refills. Members who have not had a recent prescription filled and are prescribed a short-acting agent—a category of opioid which includes morphine, oxycodone and hydrocodone, and is often used to treat breakthrough pain in patients using long-acting agents like OxyContin, Butrans and transdermal systems with fentanyl—will have their initial fill limited to five days. Blue Care, which already limited such medication to 15 days, will also move to a five-day fill limit.

"We decided after looking at utilization to limit the first fill on short-acting opioids, predominately used for acute pain episodes—minor dental or surgical procedures—to a five-day supply," said Glen Perry, Blue Cross' director of pharmacy contracting and sales. He also noted that exceptions will be made for certain cases, such as cancer patients who need medication with a longer fill limit. As for reaction from providers or members, Perry said that Blue Care received no complaints following the policy change, and expects the same for Blue Cross.

As Crain's Detroit Business noted, the move to limit opioid prescriptions has already taken place with several health insurers. Independence Blue Cross in Philadelphia limited supplies to members with acute pain to five days, while several Michigan-based companies, including Priority Health and Health Alliance Plan adopted similar policies.

Priority has eliminated 90-day prescriptions for opioids altogether and limits long-acting opioids to 30 days and short-acting to 15, while Health Alliance, which also has a 30-day limit, also requires prior authorization for certain opioids. According to the company, the latter restriction has cut OxyContin use among its members in half.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.