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What's new for 2019: Advanced opioid management program

12/27/2018

In response to the national opioid epidemic, we will launch in January 2019 a new, advanced opioid management program engaging pharmacies, prescribing health care providers and members.

The goal is to help members safely treat their medical conditions while limiting the potential for drug misuse or abuse.

The program will:

  • Monitor a member’s cumulative morphine equivalent dose (MEqD), across all opioid claims history, and identify for further clinical review any dose that exceeds more than 200 MEqD in the past 180 days
  • Set a seven-day supply limit for the first fill of short-acting opioids
  • Provide real-time alerts to dispensing pharmacists about any concerns related to the member’s clinical safety or medication use
  • Have a trained opioid neuroscience pharmacist contact a member each time he/she fills:
    • two or more different short-acting opioids within 30 days
    • two or more long-acting opioids within 21 days as prescribed by two or more providers
    • three or more different opioids or a 3-drug combo
  • Use case management and utilization management to ensure drugs are being filled and used properly
  • Direct members, if applicable, to one treating provider to get prescriptions and better coordinate care 

This program will apply to all ConnectiCare members.

Please be aware that Express Scripts, our pharmacy benefit manager, may send letters to you and your patients under this program.