New Opioid Prescribing Policy Takes Effect October 1
On August 23, 2017, the state Health Care Authority (HCA) announced a new clinical policy about opioid prescribing for Apple Health (Medicaid). This new policy will take effect on October 1, 2017. *
All Medicaid providers should have received a letter from HCA on August 23, which explains the impetus for the policy, a summary of the policy, and information about online resources and webinars that will explain the policy. In the letter, HCA notes they coordinated with several medical organizations who support the policy. WSDA is not listed because WSDA and dentists were omitted from the policy development process. Both the HCA and the Governor’s office have assured us that such oversight will not happen again.
The policy focuses on acute prescriptions and the transition from acute to chronic use. The policy limits the quantity of opioids that can be prescribed to opiate naïve patients for non-cancer pain. The limits for new opioid prescriptions will be:
- No more than 18 doses (approximately a 3-day supply) for patients age 20 or younger.
- No more than 42 doses (approximately a 7-day supply) for patients age 21 or older.
These limits can be overridden, if medically necessary, by adding “Exempt” in the text of the prescription, similar to adding “Dispense as Written” to limit substitutions.
HCA plans to provide informational materials on their website, including a Q&A for providers and pharmacists, detailed scenarios to explain how the policy applies in different situations, and a patient handout.
HCA will be hosting an informational webinar on Tuesday, September 19th from 7:00am-8:00am
*Since announcing the policy, HCA has chosen to delay implementing the 90 MED limit and peer-to-peer review requirements.