Opioid management

The use of opioid drugs has the potential to lead to patient abuse, addiction and diversion of these drugs. It can also be associated with increased costs due to excessive health care utilization.

Priority Health has an Opioid Utilization Management policy outlining our strategy to reduce opioid use by 25% within 3 years, by:

• Reducing the number of short-acting dose units by 50%
• Increasing the number of members in substance abuse treatment
• Reducing the number of members receiving prescriptions from multiple providers
• Reducing the number of members experiencing opioid-related overdose and/or death

Read the Opioid Utilization Management policy

Opioid Exception authorization request form

Use the tools below to help patients manage chronic pain pharmacologically. These recommendations do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations for individual circumstances may be appropriate.

Clinical practice guidelines

• Providers must be listed on the (Substance Abuse and Mental Health Services) SAMHSA administration website as certified.
• Claim must be billed with POS 58

Processing Medicare claims manual

40.1 - Place of Service (Rev. 4524 Issued; 02-14-20: Effective; 01-01-20: Implementation: 03-16-20) 

Claims for OTP services should use Place of Service code 58 (Non-residential Opioid Treatment Facility - a location that provides treatment for OUD on an ambulatory basis. Services include methadone and other forms of MAT).

Resources

• Opioid Prescribing in Adults Excluding Palliative and End-of-Life Care
• CDC Guidelines for Prescribing Opioids for Chronic Pain
• Section II.G.: Medicare Coverage for Opioid Use Disorder (OUD) Treatment Services Furnished by
  Opioid Treatment Programs (OTPs)

More clinical resources

Resources on the CDC website (Pocket Guide includes: Tapering, Fact Sheet, Checklist, Nonopioid treatments, Calculating Dosage, PCMPs, etc.) 
Updated 02/2017

Opioid dose calculator
Fill in the mg per day for whichever opioids your patient is taking. the tool automatically calculates the total morphine equivalents per day.
Updated 02/2017

Selected nonopioid analgesics: analgesic dosage and comparative efficacy to standards
References the effectiveness of nonopioid analgesics
Updated 07/2017

Pain management agreement 
An agreement between physician and patient regarding pain management medication (required for Medicaid members)
Updated 08/2013