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Dear Provider,
On October 1, 2017, a new Health Care Authority (HCA)
clinical policy pertaining to opioid prescriptions takes effect for Apple
Health (Medicaid), both through managed care organizations and fee-for-service.
We’re writing to make you aware of the policy
and to ask you to “save the date” for a one-hour webinar about the policy.
The
webinar will be offered twice in September.
As you are certainly aware, opioid use disorder (misuse and
addiction) is a public health crisis in Washington State and across the
country.
In October 2016, Governor Inslee issued Executive
Order 16-09, marshalling the state’s resources to combat this crisis. These
efforts include preventing opioid use disorder as well as treating it.
HCA’s opioid clinical policy is a prevention and patient
safety tool. The focus is on acute prescriptions and on the transition from
acute to chronic use, since these are critical to reducing long-term opioid use
and the risk of developing opioid use disorder.
HCA
coordinated with the Washington State Medical Association, Washington State
Hospital Association, health plan partners, and others in developing the
policy, which aligns with recommendations of the Centers for
Disease Control, the Washington State Agency
Medical Directors Group, and the Bree Collaborative
around safe and appropriate opioid prescribing.
Risk of long-term opioid use goes up with every day’s supply
on the initial prescription, and with every refill. By prescribing the lowest
effective dose for the shortest time needed, you can help prevent opioid use
disorder.
The policy limits the quantity of opioids that can be
prescribed to opiate naïve patients for non-cancer pain. The limits for new opioid
prescriptions will be:
- No more than 18 doses (approximately a 3-day supply) for
patients age 20 or younger.
- No more than 42 doses (approximately a 7-day supply) for
patients age 21 or older.
- You can override these limits if you feel this is medically
necessary, by typing “Exempt” in the text of the prescription.
At the point of transition from acute to chronic opioid
treatment—defined as six weeks of therapy—the policy requires that you attest
that you are following best practices for opioid prescribing.
These are listed
on the HCA Chronic Opioid Attestation form, which will soon be available
online, and include actions such as:
Documentation of these practices should be in the chart, but you are not
required to submit supporting materials.
For both acute and chronic prescribing, doses
are limited to 90 MED per day, except for exemption situations, or if a
peer-to-peer consultation confirms medical necessity.
Patients who are undergoing active cancer treatment or who
are in hospice, palliative care, or end-of-life care are exempt from these
restrictions.
Patients who are already on chronic opioids will be
grandfathered under the policy, and will not be subject to these limits or to
prior authorization.
The opioid clinical policy is an important step in helping
children and adults in Washington avoid opioid use disorder, and supporting
safe and effective use of opioids.
I appreciate your engagement with this
effort to lower the effects of the opioid crisis in our state.
Sincerely,
Daniel S. Lessler, MD
Chief Medical Officer
Health Care Authority
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