Reminder: Dose limits for Medicare members’ opioid prescriptions to take effect Jan. 1

As you read in the November Record, Blue Cross Blue Shield of Michigan and Blue Care Network will be required by the Centers for Medicare & Medicaid Services to establish a dose limitation for opioid drugs prescribed to our Medicare members. This change, part of an effort by CMS to combat the epidemic of prescription opioid abuse in the U.S., takes effect Jan. 1, 2017.

All Medicare prescription drug claims that include opioids and exceed a daily morphine equivalent dose of 250 mg will require a prior authorization and clinical review by Blue Cross before they may be dispensed at a pharmacy. If a claim is stopped at the pharmacy, clinical documentation may be required. This morphine equivalent dose will be calculated using the member’s opioid prescription claims history in our system.

For full details, see the November Record article.

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