Opioid coverage changes start Sept. 1

Opioid use and abuse is a critical topic in our state, and with good reason. According to the Centers for Disease Control and Prevention, nearly 2,000 deaths in Michigan in 2015 were directly related to opioids—the seventh highest number in the nation.

To improve the health and lives of our members, Priority Health has developed an opioid management strategy to reduce opioid use and abuse. This strategy will change opioid drug coverage and ensure our members have access to assistance and treatment. Initiatives include:

  • Improving behavioral health access to opioid dependence treatment
  • Creating provider reporting to identify members who use excessive doses and/or multiple prescribers and pharmacies
  • Limiting the number of opioid prescription fills and quantities members may fill
  • Identifying high-risk opioid members and encouraging them to have naloxone on hand

Schedule of changes

Change

MyPriority®

Group

Medicaid

Medicare

Letter to members outlining 2017 pharmacy benefit changes 07/24/2017 08/15/2017 09/15/2017 N/A
Letter to at-risk members to obtain prescription for Nalaxone 07/24/2017 07/31/2017 07/31/2017 07/31/2017
Prior authorization required for long-acting opioids
09/01/2017 N/A N/A N/A
Short-acting opioids limited to a 15-day supply per fill, two fills every 3 months 09/01/2017 10/01/2017 N/A N/A
Members limited to a maximum daily dose of 120 MEqD (morphine equivalent dose) 09/01/2017  10/01/2017 11/01/2017 01/01/2016, limit is 200 MEqD
Long-acting opioids limited to a 30-day supply per fill 11/01/2017 11/01/2017 N/A N/A

For patients on long-term opioids

Providers may need to start working to reduce their patients' MEqD ahead of this change. Additional clinical resources are available in our Drugs section > Opioid management.