In response to a “growing opioid epidemic” across the state, Blue Cross and Blue Shield of Alabama is launching new opioid management strategies in April that will put new requirements on coverage provided for certain opioid medications.
Blue Cross said it has always encouraged all of its members to consult their doctors about any treatments or prescription drugs they may need, but said the company relies on physicians’ expertise to know what is best for individual patients.
“Despite this and existing strategies promoting appropriate opioid use, Alabama ranked first in the nation in the number of opioid scripts per capita in 2015,” the company wrote in a press release. “The recent BCBS Association’s Health of America report on the opioid epidemic showed over 26 percent of members in Alabama filled at least one opioid prescription in 2015, and 16 out of every 1,000 were diagnosed with opioid use disorder.”
Citing an interest in the “care and safety” of its members, BCBS said it would be making changes to its requirements when covering opioid medications that will go into effect as early as next month. According to a BCBS press release, the new guidelines for members were based primarily on 2016 guidance from the Centers for Disease Control.
Those guidelines called for nationwide changes to opioid prescribing practices when treating chronic pain. However, BCBS said none of the changes coming in April would members who have been diagnosed with cancer or those already receiving regular opioid prescriptions.
As of April 1:
— Members will be limited to a seven-day supply for the first time they fill a short-acting opioid medication like Lortab, Vicodin, Percocet, etc. If an initial fill is needed for a supply of more than seven days, members will have to ask their doctor to submit a one-time Prior Authorization (PA) for those drugs.
— Members will be required to obtain a PA for all first-time prescriptions for long-acting opioid
Medications like OxyContin and MS Contin.
— Naloxone, the antidote for an opioid overdose, will be available to most members at the generic copay to include prefilled syringes and nasal sprays.
— Evzio, an auto-injector antidote, will no longer be covered because it is a high-cost drug with the same active chemical ingredient as naloxone.