In order to align with the FDA’s recommendations for opioid usage we will be implementing a new management strategy to ensure USG has the proper safety and drug dispensing limitations, effective March 1, 2018.
The following strategy is designed to ensure safeguards and guidelines are in place with the prescribing, monitoring for patterns of inappropriate prescribing or use, and process controls for drug utilization review for opioid drugs prescribed to USG members:
- Limit Days’ Supply: The length of the first opioid prescription will be seven days for immediate-release (IR), for new, acute prescriptions for members who do not have a history of prior opioid use, based on their prescription claims. A physician can submit a prior authorization (PA) request if it is important to exceed the seven-day limit.
- Limit Quantity of Opioids: The quantity of opioid products prescribed must be consistent and not exceed Center for Disease Control (CDC) recommended limits. Prescribers who believe their patient should exceed CDC Guideline recommendations can submit a PA request.
- Require Step Therapy: Use of an immediate-release (IR) formulation will be required before moving to an extended-release (ER) formulation, unless the member has a previous claim for an IR or ER product, or the prescriber submits a PA.
USG members who have been prescribed an opioid drug for acute or chronic pain management within the last 4 months, prior to January 1, 2018, will receive notification providing additional information on these changes and any actions they will need to take to avoid disruption.