Working with your doctors, we can help determine if you are at risk for misusing or abusing opioids—pain medications like hydrocodone (e.g., Vicodin) or oxycodone (e.g., Oxycontin, Percocet) or benzodiazepines (antianxiety medicines like Klonopin) —and may limit how you can get those prescriptions.*
Limitations may include:
- Requiring you to get all your opioid or benzodiazepine prescriptions filled from one pharmacy.
- Requiring you to get all your opioid or benzodiazepine medicines from one doctor.
- Limiting the amount of opioid or benzodiazepine medicines we will cover for you.
These risks increase as your dosage increases, if you take them for a long period, even if you take them as prescribed. Your risks also increase if you get opioids from multiple doctors and pharmacies or take them in combination with other prescription drugs used for anxiety or sleep. Taking more than the required dose can create a dependency (i.e., the more you take, the more your body relies on the medicine to address your discomfort).
If we decide one or more of these limitations should apply to you, we will send you a letter in advance. The letter will have information explaining the terms of the limitations we think should apply to you. You will also have an opportunity to tell us which doctors or pharmacies you prefer to use. If you think we made a mistake or you disagree with our determination, you have the right to ask us for an appeal. See Chapter 9 in your Evidence of Coverage (EOC) for information about how to ask for an appeal.
*The DMP may not apply to you if you have certain medical conditions, such as cancer, a sickle cell diagnosis, or you are receiving hospice care or live in a long-term care facility.