New Blue Medicare Advantage Safety Feature
Pain medicines can be an important part of care, but opioid pain medicines, such as hydrocodone, oxycodone,
or morphine, require close monitoring by a health care provider to ensure that they are being used safely.
Here are some tips to help you use these medicines in a safe manner.
- Get your opioid prescriptions through only one doctor and one pharmacy. This lessens the risk for taking unsafe amounts.
- Don’t take more than the prescribed dose. Taking high doses increases the risk for side effects or overdose.
- Avoid medicines that increase your risk for side effects or overdose with opioids. These include benzodiazepine (“benzo”) medicines used for anxiety or sleep (for example, alprazolam or lorazepam), muscle relaxants, sleep aid medicines such as zolpidem, and gabapentin or Lyrica in doses greater than 2,400 mg per day. Talk to your doctor if you are taking one of these medicines.
- Never take another person’s opioid medicines.
Blue Medicare Advantage promotes the safe use of opioid medicines by incorporating the following formulary safety edits:
- Limiting the amount of each opioid that you can get at one time (formulary quantity limits). We do an additional safety review when one or more of your opioid prescriptions exceed a certain high amount of opioids. The Blue Medicare Advantage system will calculate the amount of all opioids you are currently filling. If the combined amounts go above a certain threshold and/or you have opioid prescriptions from multiple health care providers, the prescription cannot be filled at the pharmacy.
- Limiting new opioid prescriptions fills for acute (short-term) pain management to a seven-day supply. When opioids are started for acute pain management, providers should prescribe the lowest effective dose for a short duration of time (usually seven days or less). To help prevent unnecessary overtreatment with opioids for acute pain, the Blue Medicare Advantage system will monitor new, first-time opioid prescriptions to ensure that the prescribed quantity does not exceed seven days.
- Avoid overlapping fills for opioids and benzodiazepine medications.Benzodiazepines, when taken with opioid medication can increase the risk of opioid side effects and overdose. The Blue Medicare Advantage system will monitor and prevent you from filling an overlap in day supply of the two medications.
These steps will help you avoid taking unsafe amounts if multiple health care providers have prescribed opioids for you without communicating with each other, or if you are filling opioid prescriptions at more than one pharmacy.
If your doctor feels that you need higher amounts of opioid medicines than what the system will allow, greater than a seven-day supply for a new opioid prescription fill, or that it is medically necessary for you to be on both opioid and benzodiazepine medicines at the same time, he or she can ask us to cover more by submitting a coverage determination request.
Please be assured that if you have only one health care provider prescribing opioids, and you are filling typical amounts of opioid medicines, your prescriptions will not be affected. Also, if you are in hospice care or are filling a prescription for cancer medicine, your opioid prescriptions will not be affected.