Prescription pad covered with pills.

How New Blue Cross Policy is Helping Reduce Opioid Abuse

In 2019, Blue Cross Blue Shield and Blue Care Network of Michigan will continue efforts to combat the nation’s opioid crisis. To ensure members receive the safest high-quality care, Blue Cross and Blue Care Network are implementing a new process to help regulate opioid usage.

Starting Feb. 1, 2019, a prior authorization will be required the first time a member’s dosage surpasses 90 morphine milligram equivalents per day. That includes the most commonly prescribed opioids, hydrocodone and oxycodone. This revised policy affects all commercial members but does not apply to those with an oncology diagnosis or terminal illness, or individuals on Medicare.

Higher opioid dosages can provide long-term pain relief for some, but they can also increase the risk of overdose and even death. Patients who receive 100 morphine milligram equivalents per day are nearly nine times more likely to overdose compared to those on 20 morphine milligram equivalents or less.

Blue Cross and Blue Care Network understand the importance of proper pain management. Providers are encouraged to assess patients’ current dosage needs and adjust accordingly. The goal is to reduce discomfort, while keeping members’ overall health a priority.

Over the past year, Blue Cross and Blue Care Network have made significant strides in opioid treatment and overuse and abuse prevention. Through the Michigan Quality Improvement Consortium, guidelines were established to help providers manage prescriptions while treating chronic pain. They’re also educated on non-opioid alternatives such as physical therapy, lifestyle modifications, and other drug combinations.

Meanwhile, individuals currently struggling with addiction have benefited from the successful pilot program, CLIMB, which stands for Community-based, Life-changing, Individual, Medically-assisted and Based on evidence program. Launched in 2018, it was initially available to 250 Blue Care Network and BCN Advantage members, but recently expanded to include those with Blue Cross PPO.

CLIMB currently assists members at Pine Rest Christian Mental Health Services in Gaines Township near Grand Rapids and the Henry Ford Maplegrove Center in Bloomfield Hills. For more information on how Blue Cross Blue Shield of Michigan is addressing the opioid epidemic, visit the Opioids 101 online resource page at www.mibluesperspectives.com/opioids101.

Should you have any questions about your coverage or prior authorization, please contact the number on the back of your Blue Cross card.

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