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 |