Premera revises opioid policies to keep customers safe

By Dr. David Buchholz
Monday, April 16, 2018

You’ve heard it for months now: We’re facing an opioid crisis.

All of us in the healthcare sector recognize that this is a complex health issue that we should all address it. As a physician, I’ve seen firsthand the effects of long-term opioid misuse or addiction. 

One way to approach the problem is preventing it in the first place.

Effective April 16, 2018, Premera Blue Cross is making two new opioid prescription policy changes that can help keep our customers safe if they need pain control after an injury, surgery, or even a trip to the dentist.  

Here are the two changes:

  • A provider can write a short-acting opioid prescription (such as oxycodone and hydrocodone) for a total of seven days. For prescriptions longer than seven days, providers need to get prior authorization.
  • If a provider needs to write a long-acting opioid prescription (such as extended release morphine or oxycodone), the patient must have been treated with a short-acting opioid first. If the patient doesn’t have a record of taking short-acting opioids in the past 130 days, the provider needs to get prior authorization.

My hope is that these changes will help reduce the risk of the next generation of chronic opioid users.

How can two policy changes make a difference?

These safety changes limit the duration of opioid prescriptions for customers who are “opioid naïve,” meaning they haven’t received an opioid prescription in the past 130 days. This is part of Premera’s ongoing effort to prevent opioid misuse and addiction.

The Centers for Disease Control (CDC) reports that the likelihood of long-term opioid use increases based on the length of the initial prescription. The risk increases sharply after the 3rd day of taking a prescription opioid and continues to increase daily from there.

Most people don’t need more than a seven day supply for an acute injury or after surgery. We don’t want extra opioids left around in the medicine cabinet that a teenager can take and experiment with or share with friends.

All Providers, Including Dentists

Providers of all specialties, including dentists, need to follow these new safety policies, regardless of their location or Premera contract status. If a patient goes to the pharmacy and the pharmacist tries to fill the prescription that doesn’t meet the new guidelines, then the pharmacist will call the provider. This is another way for us to provide opportunities for ongoing education for both patients and providers.

The Journal of the American Dental Association reported that dentists are the leading opioid prescribers to teens. The American Dental Association (ADA) policy follows the CDC’s opioid prescribing recommendations to help reverse this trend. Our new safety changes align with the CDC's opioid prescribing guidelines

We estimate that the policy changes will affect about 21,500 pediatric and adult customers this year. That’s 21,500 people we could potentially prevent from becoming a long-term opioid user.

The changes don’t affect patients already receiving opioid treatment, cancer patients, or patients receiving end-of-life or palliative care. For this group, Premera works with our pharmacy manager, Express Scripts, to monitor our customers and intervene when we see signs of overuse or abuse.

blog-portrait-buchholzTalking with my colleague Dr. Mia Wise, another medical director at Premera, she shared my view that changing opioid prescribing habits will take time, just like it did with overprescribing of antibiotics. “We have to acknowledge people’s pain and be compassionate. Some of Premera’s best strategies are around reducing risk,” she said. “If these edits work as they’re intended, it’s going to make it easier for providers to do the right thing.”

Dr. David Buchholz is a medical director at Premera Blue Cross.


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