Health First Colorado Initiatives Cut Opioid Use More than 50 Percent

Fewer members using opioids — those who are, are using less

FOR IMMEDIATE RELEASE

July 24, 2019

Media Contact:
Marc Williams
303-866-3144

Denver, CO – The opioid epidemic has impacted individuals and families across the country. Coloradans and those covered by Health First Colorado (Colorado’s Medicaid program) are no exception. Over the past five years, the Colorado Department of Health Care Policy & Financing (Department) has implemented several effective initiatives to help Health First Colorado members avoid the devastating consequences of excess opioid prescribing and utilization. Those policy initiatives have been aimed at reducing the number of opioids prescribed to members, tightening criteria when requesting refills and reducing the daily Morphine Milligram Equivalents (MME) members can take – all while continually ensuring members receive necessary medications for adequate pain management.   

These initiatives, along with provider collaboration, education and evolving public awareness of the opioid crises, have helped the Department achieve and maintain a more than 50 percent reduction in the number of opioid units dispensed to members, as well as a 44 percent reduction in the number of Health First Colorado members using opioids during the 5-year period 2014 through 2018.  

“This analysis confirms the steps we’ve taken over the past five years are making a significant, positive impact in reducing our members’ opioid use,” said Director of Pharmacy Cathy Traugott. “Our opioid policies will continue to evolve, consistent with clinical guidelines, to minimize the destructive effects that opioids can have on our members and their families.” 

The analysis tracks five years of data from calendar year 2014 through calendar year 2018, during which time the Department has seen:  

  • A 51 percent decline in opioid claims 
  • A 64 percent reduction in gross opioid expenditures amounting to more than $1 million in avoided pharmacy costs.  

“Our approach to managing opioid utilization must be comprehensive,” said Executive Director Kim Bimestefer. “It is critical we collaborate with providers to reduce inappropriate and excessive opioid prescribing practices to prevent addiction, support providers with the proper tools to better manage and treat our members and meet the individual pain management needs of members to ensure their quality of life. Our comprehensive, person-centered approach is helping Health First Colorado serve our members while effectively combatting opioid misuse and addiction.”  

Over the past five years, the Department has implemented the following policies:  

2014

  • Tightened criteria on short-acting opioids and added quantity limits.  
  • Created a pain resource webpage with topics related to opioid use/misuse, pain assessment guides, risk assessment tools and methods to reduce opioid use safely and effectively.   

2015

  • Created a pain specialist consultation program to assist providers and decrease inappropriate use of opioids. 
  • Sent letters to prescribers regarding their prescribing habits and their patients who are obtaining opioids from multiple providers. 
  • Established the Chronic Pain Disease Management Program through which experts and specialists trained providers in appropriate use of opioids. 

2016

  • Established a daily MME limit and set the initial amount at 300 MME/day.  
  • Added a buprenorphine training component to the Chronic Pain Disease Management Program to expand the number of buprenorphine providers. 

2017

  • Limited initial prescription fills to a 7-day supply and limited the member to two refills; a fourth refill request requires a physician authorization. 
  • Reduced the daily MME from 300 MME/day to 250 MME/day.

2018

  • Further reduced the daily MME from 250 MME/day to 200/per day. A prescription which puts a member above 200 MME/day requires a prior authorization. 
  • Implemented a dental opioid policy limiting members to three, four-day prescription fills, with a fourth refill request requiring prior authorization.

The Department will continue to explore options to further reduce the daily MME limit as well as strengthen rules when opioids are prescribed with benzodiazepines. 

In 2020, the Department will launch a tool to help providers reduce the chances of addiction among their patients. The tool is being designed in collaboration with physician groups, hospitals, insurance carriers, and opioid management experts.


About the Colorado Department of Health Care Policy and Financing: The Department administers Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus and other programs for Coloradans who qualify. For more information about the Department, please visit Colorado.gov/hcpf.

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