By Mark Tosczak

Blue Cross and Blue Shield of North Carolina announced changes to its opioid prescription policies, in part because the company said it still processes thousands of prescriptions each month that violate limits enacted by the state legislature last year.

Blue Cross announced Thursday it would limit first-time prescriptions of short-acting opioids to seven days. First-time prescriptions for long-acting opioids will require pre-authorization. And the company said it would start to cover Sublocade, an injectable drug intended to treat opioid addiction.

The changes go into effect Sunday.

The new policies will affect the company’s fully insured customers, about 1.5 million people. It will not affect people covered by the State Health Plan, the Federal Employee Program, Medicare Part D plans or self-funded employer groups that use a different company to administer pharmaceutical benefits. Blue Cross is the state’s largest health insurer.

“The policies we’re announcing today are the latest in a series of efforts from Blue Cross NC that will help prevent opioid addiction, treat opioid dependency, and save lives,” said Dr. Rahul Rajkumar, the company’s chief medical officer. “You will see more from us.”

Patients who are already on extended- release opioids will be approved based on their claims history or their physician documenting their current treatment.

In June 2017, North Carolina enacted the Strengthen Opioid Prevention Misuse Act, or STOP Act, which limits how the amount of short-acting opioid drugs that can initially be prescribed to patients. Despite that, Blue Cross says, its claims systems shows that 2,000 to 4,000 prescriptions each month exceed the seven-day limit.

The policy change comes as North Carolina battles rising rates of opioid-related emergency room visits.

In February, Blue Cross announced it would spend $10 million on opioid-related initiatives. That includes $1 million to help Durham-based drug treatment program TROSA to expand into the Triad and funding for a UNC School of Government program to pilot community-based solutions to the opioid problem in up to 10 communities.

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Mark Tosczak

Mark Tosczak has worked as a writer and communications professional for more than 20 years, including stints as a newspaper reporter and editor, think tank communications director, marketing agency vice...

One reply on “Blue Cross Tightens Rules on Opioid Prescriptions”

  1. Oh, the frustrations of intractable pain patients everywhere! Sigh…????
    Wheelchair sales claims, and disability claims, are going to rise. All in a misguided attempt that does not address the root problem.

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