BlueCross Makes Changes to Opioid Coverage in 2019

Pharmacy efforts aim to further address addiction epidemic in Tennessee

CHATTANOOGA, Tenn. — As the opioid crisis continues to impact communities across the state and around the country, BlueCross BlueShield of Tennessee is implementing the next phase of its clinical efforts to combat misuse and unintentional overuse of prescription painkillers.

Beginning Jan. 1, these commercial coverage changes include:

  • A seven-day quantity limit for short-acting opioid prescriptions issued to members who are receiving the drug for the first time.
  • An enhanced prior authorization requirement for extended use of short-acting opioids. Specifically, this will impact those who use more than 30 days’ worth of short-acting medication in a 90-day period.
  • A lower threshold for morphine milligram equivalent dose (MME), with authorization required for more than 120 milligrams of opioids per day.
  • Removal of OxyContin from the list of covered drugs, to be replaced with drugs less likely to be abused.
  • Drug combination safety alerts for clinical teams and providers, which highlight inappropriate or dangerous drug combinations in order to promote appropriate use.
  • Addition of a benefit for alternative pain therapy.

BlueCross leaders developed these changes with input from a statewide panel of independent medical experts, including public health officials and practicing clinicians. As with previous clinical changes, BlueCross will approve prior authorization requests for members with cancer or those who are receiving palliative or end-of-life treatment. Medicare Advantage and BlueCare (TennCare) members are not affected by these changes.

The company hopes these changes will build on the success of its previous clinical and social efforts to reduce the supply of opioids. Positive changes from 2015 to 2018 have included 19 million fewer pills dispensed and a 26 percent decrease in opioid prescription claims, along with a drop in the strength of the opioids being used.

“These efforts are motivated by a desire to ensure the safety and wellbeing of everyone in the state, not just the members we serve,” said Dr. Andrea Willis, chief medical officer for BlueCross.

“Our clinical and social approach aims to help ensure that BlueCross members – and eventually all Tennesseans – receive the appropriate amount of opioids for their medical conditions while limiting the potential for misuse and abuse.”

BlueCross leaders emphasize that changes have been developed and implemented gradually to minimize any possible disruption for members.

“We are fully aware that many of our members face the reality of chronic pain, and many more may have situations arising from injury or surgery where pain medication – including opioids – may be part of a legitimate and necessary treatment plan,” said Dr. Natalie Tate, vice president of pharmacy for BlueCross.

“We do not want to be disruptive or cause undue hardship, which is why we’ve taken this moderate and measured approach to changes in our coverage.”

About BlueCross®

BlueCross BlueShield of Tennessee’s mission is to provide peace of mind through better health. Founded in 1945, the Chattanooga-based company is focused on serving more than 3.5 million members in Tennessee and across the country. BlueCross BlueShield of Tennessee Inc. is an independent licensee of the BlueCross BlueShield Association. For more information, visit the company’s website at bcbst.com.

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