Opioid drugs

Opioid quantity limits

Use the Opioid Exception form to request exceptions to these quantity limits specified in our Opioid Utilization Management Policy 11/0129:

  • Daily limits, commercial and Medicaid members: Patients are limited to a total of 120 MEqD per day
  • Monthly limits, commercial members: Short-acting opioids are limited to an amount needed to last up to 15 days, with a maximum of two prescriptions within 3 months (90 days).

Applies to:

Long-acting/extended release opioids

Preferred

Non-preferred

OxyContin® (oxycodone ER) Embeda® (morphine ER/naltrexone)
morphine ER tablet Arymo™ ER (morphine ER)
tramadol ER tablet Xtampza™ ER (oxycodone ER)
fentanyl transdermal patch Hysingla™ ER (hydrocodone bitartrate)
methadone Zohydro™ ER (hydrocodone bitartrate)
  Nucynta® ER (tapentadol ER)
  Belbuca™ (buprenorphine buccal tablet)
  oxycodone ER
  oxymorphone ER
  hydromorphone ER
  buprenorphine transdermal patch

Short-acting opioids

astramorph  Nucynta®
codeine
Oxyado
codeine/acetaminophen
oxycodone (Roxicodone®)
duramorph
oxycodone/acetaminophen
fentanyl (Abstral®, Actiq®, Subsys®, Lazanda™, Fentora®, Ionsys®)
oxycodone/Aspirin
hydrocodone/acetaminophen
oxycodone/ibuprofen
hydrocodone/ibuprofen
oxymorphone (Opana®)
hydromorphone (Dilaudid®)
pentazocine/acetaminophen
levorphanol
pentazocine/naloxone
meperidine (Demerol®)
tramadol
meperidine/promethazine
Xartemis® XR
morphine sulfate