Like you, Highmark sees the safe, effective use of prescription drugs by our members, your patients, as a main priority.

That is why, effective March 8, 2018, Highmark implemented opioid measures designed to assist the clinically appropriate use of these medications while proactively preventing the development of opioid use disorder.

There will be exceptions for members with cancer or other terminal illnesses.

These measures follow CDC and Highmark guidelines:

• Short-acting opioids: For individuals new to therapy, initial prescriptions will be limited to seven days. Prior authorization applies. These patients will receive a maximum 14-day supply for short-acting opioids within a 30-day period without additional authorization, provided that each prescription does not exceed the seven-day limit.
• Long-acting opioids: Prior authorization is required, with confirmation of diagnosis, for new users to initiate therapy.

Highmark designed these measures with member safety as the primary goal.

“Even at low doses, taking an opioid for an extended period of time increases the risk of addiction,” said Sarah Marche, PharmD, vice president of Pharmacy Services for Highmark Inc. “The idea of this program is to stop inappropriate, long-term use at the outset. This policy is completely about the safety of our members and the communities that we serve.

“Data from the CDC show that people who use opioids for just one day have a 6 percent chance of becoming addicted,” Marche added. “For those who use opioids for more than a week, the chances increase to more than 13 percent.”

She noted there are some exceptions to the program, including members who have a condition that causes chronic pain that can’t be managed with other treatments or who may need opioids for acute or chronic pain associated with cancer or other malignant conditions.

Valuable resources can be found on the website for Pennsylvania's Prescription Drug Monitoring Program (PA PDMP). These resources can assist you in identifying patients struggling with substance abuse disorder. The site also offers access to other expansive resources, including:

• Prescriber Q&A
• PDMP Tutorials & Policies
• Opioid Prescribing Guidelines
• Patient Education Materials
• Provider Resources on:
• Talking with Patients About Their Drug Use
• Identifying Red Flags for Addiction and Diversion
• State Resources Available to You

You also can consult Highmark's Clinical Practice Guideline for opioid use that's available on our online Provider Resource Center. On the Resource Center, click on Education/Manuals and then on Clinical Practice and Preventive Health Guidelines. In the 2018 Clinical Practice Guidelines section, click on Prescribing Opioids for Chronic Pain Guideline and Key Points.

Highmark will remain vigilant and continue to support you in addressing the opioid crisis to keep our members — your Highmark patients — safe. Watch Provider News for updates about these ongoing efforts.