Update to allow 30-day supplies of short-acting opioids

As of May 2018, Priority Health has updated its Opioid Management Policy to allow members using short-acting opioids for chronic (≥72 days of use in the last 90 days) pain management to fill 30-day supplies. Previously, all members were restricted to 15-day supplies.

Members utilizing short-acting opioids for acute pain are still limited to 15-day supplies and 2 fills in 90 days.

Members using ≤ 50 MED/day

Beginning mid-May, automated logic will allow members who use exclusively short-acting opioids at a level of 50 MED/day or less to receive 30-day supplies at the pharmacy. This process will be automated and members will not require a clinical review or authorization for claims to process.

Members using ≥ 51 MED/day

This amount of opioids will require review through the authorization/exception process. If the member meets the criteria outlined in the Opioid Management Policy, they will be approved to fill 30-day supplies for 12 months.