April 13, 2018
Premera is updating its opioid prescription policy to include two new safety edits. The edits are effective April 16, 2018 and only apply to opioid prescriptions made to adult and pediatric patients without a history of opioid use (within the past 130 days, beginning with the policy’s start date).
They won’t impact long-acting opioid users.
Safety edit 1: If your patient is opioid naïve (doesn’t have a recent history of taking opioids and/or has never taken opioids), you need to first prescribe a short-acting opioid with a maximum 7-day supply.
When treating opioid naïve patients, you’ll need to request prior authorization for initial opioid prescriptions that exceed 7 days of supply.
Safety edit 2: When you prescribe an initial, long-acting opioid prescription, your patient needs to have been previously treated with short-acting opioids.
If we have no recent claims records of a short-acting opioid prescription (dating back 130 days), you’ll need to submit prior authorization. We won’t have claims records for patients that are new to Premera at the time of prescription. Even if they have a recent history of taking a short-acting opioid, this will trigger a prior authorization and you’ll need to submit their medical records for approval.
Our pharmacy staff will be available 7 days a week and holidays to manage urgent prior authorization requests.
Why we’re making this change
We’re making this change to help prevent addiction and align with the latest guidance from the Centers for Disease Control and Prevention (CDC).
Preventing addiction is one of three ways we’re responding to the opioid crisis. We’re also working to reduce the risk of opioid overdose and help our members with opioid use disorder receive treatment.
If you have any questions, view the policy update on Premera.com or contact Dan Danielson.