Colorado's Medicaid program to tighten opioid usage policy

DENVER, Colo. -- In a continued effort to address the growing opioid epidemic in Colorado, the Department of Health Care Policy and Financing announced Monday it is tightening its policy on prescribing and dispensing opioid pain medications to members of Colorado's Medicaid program, Health First Colorado.

The new policy will be implemented in two phases. The first phase is effective August 1, 2017 and limits the supply of opioids to members who haven't had an opioid prescription in the past 12 months.

"The goal of this new policy is twofold," said Dr. Judy Zerzan, chief medical officer for the Department. "First, to reduce the number of Medicaid members who might develop an addiction to opioids when it could be prevented. Second, to reduce the amount of excess opioid pills in the community."

Under the current policy, Health First Colorado members are allowed up to a 30-day initial supply with subsequent fills as prescribed by their doctor.

The policy was developing following a Department analysis of claims data showing a growing number of Health First Colorado members who have not taken opioids before - or have not taken them for up to one year - go on to using them more frequently. The Department wants to ensure members have appropriate medication to treat their acute pain, without excessive doses that are not needed. The new policy will allow:

  • A 7-day supply to be filled initially,
  • Two additional 7-day refills, but a fourth refill request will require providers to obtain prior authorization from the Department.
  • The fourth request could also require a consultation with a pain management physician from the Department's Drug Utilization Review board.

The second phase of the policy begins October 1, 2017 and will reduce the daily Morphine Milligram Equivalents (MME) for members currently on a pain management regiment. Under this new policy, the total daily limit of MME will decrease from 300 MME per day to 250 MME per day.

  • Under the new policy, a prescription that puts the member above 250 MME per day will be rejected and require a prior authorization. In some circumstances, a consultation with the Department's pain management physician may be required.

The Department is recommending that providers and their teams begin tapering Medicaid members to or below the 250 MME per day threshold prior to October 1. The new 250 MME limit will not apply to members in palliative or hospice care, nor those being treated for cancer.

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