Opioid rules and prior authorization implementation dates approaching

A reminder to all prescribers and practices that the Vermont Department of Health Rule Governing the Prescribing of Opioids for Pain and Vermont Prescription Monitoring Program Rule go into effect July 1, 2017.  That gives practices two more weeks to prepare. For more information, please see the VMS Opioid Prescribing webpage and archived webinar material.
A number of Vermont health care insurers are instituting prior authorization processes intended to complement the Department of Health Rules.

DVHA/Vermont Medicaid:

  • Effective 7/5/17, initial opiate prescriptions for patients 18 years and older will be limited to 50 MME per day and a maximum of 7 days’ supply. Patients 17 years of age and younger will be limited to 24 MME per day and a maximum of 3 days’ supply. If there is a documented clinical need to support exceeding these limits, a prior authorization will be required.   Click here for more information.

BlueCross BlueShield of Vermont

  • Effective 7/5/17, prescriptions for opioid naïve patients cannot exceed: 7-day supply for patients 18 years old or older or 3-day supply for patients under 18.  This applies to any CII, CIII and/or CIV IR opioids (including tramadol) but excludes MAT opioids.   A prior authorization will be required to for any prescription to exceed the maximum-day supply or if a long-acting opioid is necessary for an opioid-naive patient.  Click here for more information. 

Cigna

  • Prior authorization may be required prior to certain prescriptions or if prescription exceeds certain thresholds.  Click here for more information. 

MVP:

  • VMS is not currently aware of new PAs being instituted by MVP 

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