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As misuse, abuse, and overdose become more common
in patients who have been prescribed narcotic therapy,
health care providers and managed care organizations
are faced with the challenge of controlling overutilization.
The most recent data shows that more than 16,000 lives
are lost each year due to opioid-related overdoses. The
death toll from accidental overdose has surpassed that
of motor-vehicle accidents, making it the leading cause
of death for the first time in the history of the United
States.1
To help facilitate more appropriate usage and
prescribing, Independence will require prior authorization
on all high-dose and high-potency narcotics effective
January 1, 2015.
Prescribing narcotic therapy
Independence encourages you to keep in mind the
following information when prescribing narcotic therapy
to your patients:
- The most commonly abused opioid prescription
drugs are: codeine, morphine, methadone, oxycodone
(Oxycontin®), hydrocodone, hydromorphone,
oxymorphone, meperidine, and fentanyl.2
- The recommended maximum daily morphine
equivalent dose (MED) should not exceed 120 mg per
day. Above this dose, risks of physical dependence,
tolerance, and adverse reactions must be balanced
with the pain relief benefit as well as functionality and
quality of life issues.3
- Consider the balance of long-acting and short-acting
medications. The current recommendation for dosing
breakthrough medication is 10 ? 15 percent of the daily
long-acting dose.4
- Fentanyl patches should not be used in patients
without sufficient body mass. Absorption is decreased
in cachetic patients because the drug accumulates in
skeletal muscle and fat and is then slowly released into
the blood.
- Ultram® became C-IV as of August 18, 2014.
- Hydrocodone (e.g., Vicodin®, Lortab®) became
C-II
on October 6, 2014. These products will no longer
be able to be called in to pharmacies or be refilled. A new hardcopy
prescription will need to be issued
for each fill.
When additional help is needed, providers should
instruct patients to contact their mental health/
substance abuse services provider. Members with
Magellan Behavioral Health, Inc. coverage can call
1-800-424-4238.
Look for more information on prescribing narcotic
therapy in future editions of Partners in Health
UpdateSM.
1 Pennsylvania Guidelines on the Use of
Opioids to Treat Chronic
Noncancer Pain. Pennsylvania Medical Society.
2
www.drugabuse.gov. National Institute of Drug Abuse.
3 Franklin, Gary M. Opioids for chronic
noncancer pain: A position
paper of the American Academy of Neurology. Neurology 2014;
83; 1277-1284.
4 McPherson, Mary Lynn. Demystifying Opioid
Conversion
Calculations: A Guide for Effective Dosing.
Magellan Behavioral Health, Inc., an independent company,
manages
mental health and substance abuse benefits for most Independence
members.
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