Changes in the way opioids are prescribed at PMC

MEEKER | “Prescription opioid abuse—including painkillers such as OxyContin, Percocet, Vicodin, Percodan, Tylox and Demerol—is a serious problem across our state,” according to Dr. Chris Williams, chief of staff at Pioneers Medical Center. In 2015, 259 people died of prescription opioid overdose. As of Aug. 1, Pioneers Medical Center is implementing new Medicaid policies for opioid prescriptions and prescription refills.
“We feel that by participating in these new procedures, we will minimize risk for addiction to these highly addictive drugs,” Williams said.
The Department of Health Care Policy and Financing (HCPF) announced it is tightening its policy on prescribing and dispensing opioid pain medications to Health First Colorado (Colorado’s Medicaid program) members. The new policy will be implemented in two phases.
The first phase is effective Aug. 1, and limits the supply of opioids to members who haven’t had an opioid prescription in the past 12 months.
The policy was developed following a department analysis of claims data showing a growing number of Health First Colorado members who have not taken opioids before—or have not taken them for up to one year—once they start opioids go on to using them more frequently. The department wants to ensure members have appropriate medication to treat their pain, without excessive doses that are not needed. The new policy will allow:
A seven-day supply to be filled initially and two additional seven-day refills. A fourth refill request will require providers to obtain prior authorization from the department.
The fourth request could also require a consultation with a pain management physician from the department’s drug utilization review board.
Under current policy, Health First Colorado members are allowed up to a 30-day initial supply with subsequent fills as prescribed by their doctor.
First, we want to reduce the number of Medicaid members who might develop an addiction to opioids, said Williams. “And, second, we want to reduce the amount of excess opioid pills in the community.”
There is a second phase to the new policy that addresses narcotic prescription usage. This second policy will reduce the daily Morphine Milligram Equivalents (MME) for members currently on a pain management regimen. Beginning Oct. 1, there will be a maximum daily limit on morphine equivalents in narcotic prescriptions.
Pioneers Medical Center takes the rising epidemic of opioid addiction very seriously and is committed to following these policies. We feel this is in the best interest of our patients. We, therefore appreciate everyone’s patience with the new processes. Although HCPF is leading the way on this initiative, many private insurance companies are also implementing these procedures.
The Colorado Department of Health Care Policy and Financing 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, please visit Colorado.gov/hcpf.