Colorado Medicaid to Further Tighten Opioid Policies
New policies impact dental prescriptions and maximum daily limits
FOR IMMEDIATE RELEASE
October 31, 2018
Denver, CO – In an ongoing effort to address the opioid epidemic in Colorado, today the Department of Health Care Policy and Financing (Department) announced it is reducing dental prescriptions for short-acting opioids and reducing the daily maximum Morphine Milligram Equivalent for Health First Colorado (Colorado’s Medicaid program) members effective November 15, 2018.
The new dental opioid policy will allow members to receive three, four-day prescription fills and a fourth refill request will require further approvals. In each fill, the quantity limit for dental opioids will be 24 pills. Members undergoing more complex dental procedures such as major orofacial surgery, may be approved for up to a seven-day supply and up to 56 pills per fill.
The second piece of the opioid policy update will reduce the daily Morphine Milligram Equivalents (MME) for members currently on a pain management regimen. Beginning November 15, 2018, the total daily limit of MME will be decreasing from 250 MME per day, to 200 MME per day. If a prescription puts a member above 200 MME per day, further approvals will be required to allow time for the prescriber to work with the member to safely taper opioid doses down to 200 MME, while making sure the member has adequate pain control. In some circumstances, a consultation with the Department’s pain management physician may be required.
“By decreasing utilization of opioids, the Department’s goal is to reduce the chance of addiction, overdose and death while still providing pain relief and support for our members while they are tapering down from higher doses,” said Cathy Traugott, pharmacy section manager for the Department. “Numerous clinical guidelines use 120 MME as the standard so the Department's intention is to get down to clinical guidelines though a stair step approach. This ensures that people over the limits have time to safely taper their dosage while adequately managing pain.”
The updated policy reducing overall daily maximum MME builds on the success the Department has seen since August 2017 when it lowered the daily maximum from 300 MME to 250 MME. As with the current policy, exceptions will be taken into consideration for Health First Colorado members with disabilities and others when chronic pain management exceeding these limitations may be needed.
“In each of the last three years, we’ve seen a cumulative 30 percent reduction in both the number of pills prescribed in the Medicaid program and the number of people taking opioids within the Medicaid program. To our members, that means we are lowering the risk of opioid addiction,” said Executive Director Kim Bimestefer. “We are pleased with that record of performance, and are confident our evolving opioid policies will continue to reduce addiction and the destructive impact it has on individuals and families.”
The Department recommends providers begin tapering Medicaid members to or below the 200 MME per day threshold prior to November 15, 2018. The new 200 MME limit will not apply to members in palliative or hospice care, nor those being treated for cancer.
Learn about Health First Colorado pharmacy benefits and read this fact sheet for more information on other steps the Department has taken to address opioids.
About the Colorado Department of Health Care Policy and Financing: The Department administers Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus as well as a variety of other programs for Coloradans who qualify. For more information about the Department, visit Colorado.gov/hcpf.