When appropriate, the length of the first prescription fill will be limited to seven days for new, acute opioid prescriptions for members who do not have a history of prior opioid use (based on their prescription claims).

A physician can submit a prior authorization (PA) request if it is important to exceed the seven-day fill limit.

The quantity of opioid products prescribed — including those that are combined with acetaminophen, ibuprofen or aspirin — will initially be limited to ensure amount does not exceed the maximum daily dose listed in labeling. Quantities are also ≤ 90 MME or less per day and contain ≤ 4 g APAP or ASA and ≤ 3200 mg ibuprofen.

Prescribers who believe a patient should exceed CDC guideline recommendations can submit a PA request for up to 200 MME per day. Quantities higher than that would require an appeal.

Note: Quantity limits will not apply to patients with cancer, a terminal condition or pain being managed through hospice or palliative care

Use of an immediate-release (IR) formulation will be required before moving to an extended-release (ER) formulation, unless the member has a previous claim for an IR or ER product, or the prescriber submits a PA request.