Independence continues to prioritize combating the opioid epidemic in the
United States. Effective October 1, 2018, Independence?s opioid
management policy for members with a commercial benefit will be updated to
align with the most up-to-date Centers for Disease Control and Prevention (CDC)
recommendations. By updating our policy, we hope to help ensure safe and
appropriate opioid use.
CDC Guidelines for Prescribing Opioids for
Chronic Pain1
The following are some of the most important CDC guidelines providers should
use when prescribing opioids:
- Opioids should not be considered first-line or routine therapy for chronic
pain; clinicians should discuss benefits and risks and availability of
non-opioid therapies with patients.
- An opioid dose of ?90 MME/day* should be avoided, when possible, and the
clinicians should carefully justify a decision to titrate dosage to ?90
MME/day.
- Extended-release/long-acting (ER/LA) opioids should not be prescribed for
acute pain. When starting opioid therapy for chronic pain, clinicians should
prescribe immediate-release opioids instead of ER/LA opioids.
Opioid management updates for members with a
commercial benefit
The following commercial benefit changes will become effective October 1,
2018:
- Cumulative daily limit of 90 MME will be applied across all opioids:
- This limit is calculated based on the total daily dose of the opioid drug,
by itself or in combination with other opioids.
- For members whose opioid dose exceeds 90 MME/day, prior authorization is
required.
- All long-acting opioid products will require prior authorization. This
update only applies to products that do not currently have a prior
authorization in place.
- All short-acting opioids will be limited to a 5-day supply. This update
only applies to products that do not currently have a prior authorization in
place.
Formulary update regarding opioids for
members with a commercial benefit
As of October 1, 2018, Xtampza? XR (Oxycodone ER
capsules), which is an extended release, abuse deterrent form of oxycodone
similar to OxyContin?, will be the preferred long-acting oxycodone
product. Studies indicate that Xtampza? XR has the added benefit of
being more crush resistant than OxyContin?/oxycodone ER
tablet.2-3 Both OxyContin? and oxycodone ER
tablet, which is an authorized generic drug for OxyContin?, will
be on the non-preferred drug tier on the Independence Select Drug
Program? Formulary and will be removed from coverage on the Value
Formulary. A trial of Xtampza? XR will be required prior to
OxyContin? and oxycodone ER tablet approval.
Physicians who have members affected by these changes will be notified
directly.
Conversion from other oral oxycodone
formulations to Xtampza? XR4
Patients receiving OxyContin? or oxycodone ER tablet may be
converted to Xtampza? XR by administering half of the patient?s
total daily oral oxycodone dose as Xtampza? XR every 12 hours with
food. Since Xtampza? XR is not bioequivalent to OxyContin? or oxycodone ER tablet, patients should be monitored during dosage
adjustment. For complete dosing information please refer to the FDA?s prescribing information.
The following therapeutic equivalence table for dosage strengths of
OxyContin? (oxycodone ER) tabs and oxycodone base (Xtampza? XR) is set forth in the Xtampza? XR prescribing
information4:
OxyContin? (oxycodone ER) tabs | Xtampza? XR caps |
10 mg | 9 mg |
15 mg | 13.5 mg |
20 mg | 18 mg |
30 mg | 27 mg |
40 mg | 36 mg |
60 mg | Two 27 mg (or 54 mg) |
80 mg | Two 36 mg (or 72 mg) |
Non-opioid pain management products
In an effort to reduce the number of opioids prescribed, the CDC published a
checklist recommending that non-opioid therapies be tried and optimized when
considering long-term opioid therapy. The non-opioid therapies listed below can
be used as stand-alone therapy or in combination with opioids, as indicated:
- Non-opioid medications:
- non-steroidal anti-inflammatory drugs (NSAIDs) such as meloxicam and
celecoxib
- tricyclic anti-depressants (TCAs) such as amitriptyline and nortriptyline
- serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine
- anti-convulsants such as gabapentin
- physical treatments including exercise therapy and weight loss
- behavioral treatment including cognitive behavioral therapy (CBT)
- procedural interventions such as intra-articular corticosteroids
injections
For additional information, please reference the CDC?s Checklist for
prescribing opioids for chronic pain.
*MME/day: morphine milligram equivalents per day.
1Centers for Disease Control and
Prevention. ?Guideline for Prescribing Opioids for Chronic Pain? March 18, 2016
/ 65(1);1?49. Accessed July 10, 2018. Available from: www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.
2Gudin J, Levy-Cooperman N, Kopecky
EA, Fleming AB. ?Comparing the effect of tampering on the oral pharmacokinetic
profiles of two extended-release oxycodone formulations with abuse-deterrent
properties.? Pain Med. 2015; 16(11):2142-2151. Doi:10.1111/pme.12834.
3Brennan MJ, Kopecky EA, Marseilles
A, et al. ?The Comparative pharmacokinetics of physical manipulation by
crushing of Xtampza? ER compared with OxyContin?.?
Pain Manag. 2017; 7(6):461-472
4Xtampza? XR Prescribing
Information. Accessed August 2, 2018. Available from: www.accessdata.fda.gov/drugsatfda_docs/label/2016/208090s000lbl.
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