Last Updated: Jan 29, 2019
Highmark has announced a new morphine milligram equivalents (MME) limit for commercial and ACA plans. Effective Feb. 1, 2019, Highmark will implement a 90 MME/day limit for opioid-naïve patients and members currently receiving less than 90 MME.
The new policy is based on the following recommendation from the CDC Guideline for Prescribing Opioids for Chronic Pain.
When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day
Highmark’s bulletin on the new policy is available via its Provider Resource Center here.
Cumulative opioids exceeding 90 MME can be approved when there is documentation of pain associated with active cancer treatment or cancer not in remission; hospice program, end-of-life care, or palliative care; or sickle cell anemia.
Cumulative opioids that exceed 90 MME can also be approved when the prescriber states, based on the patient’s clinical circumstances that the amount of opioid prescribed is warranted in order to adequately manage the patient’s pain.
You can also find details about Highmark’s short- and long-acting opioid management measures for its commercial plans – which took effect, on in March 2018 – in this Highmark Hot Topic bulletin.
The Pennsylvania Medical Society offers a variety of resources and CME to help Pennsylvania physicians navigate the opioid abuse crisis. For details, visit www.pamedsoc.org/OpioidResources.