Beginning August 1, 2017. If a Member does not have a prescription for opioid pain medication (e.g., Codeine, Hydrocodone, Oxycodone, Morphine, Demerol, Hydromorphone, Fentanyl and Methadone) in the past twelve (12) months, the following changes will occur:
- A seven (7) day supply will be filled initially,
- A member can obtain two (2) additional 7-day refills,
- Providers are required to obtain prior authorization from Colorado’s Department of Health Care, Policy and Financing for a fourth (4th) refill request,
- A fourth request could also require a consultation with a pain management doctor from the Department's Drug Utilization Review board. Beginning October 1, 2017, if a Member is taking Morphine Milligram Equivalent (MME), there will be a change in the total daily limit of MME. The MME will decrease from 300 MME to 250 MME. This will not apply to Members in palliative or hospice care, nor those being treated for cancer.
- A prescription that goes above 250 MME per day will require a prior authorization from Colorado’s Department of Health Care, Policy and Financing
- A consultation with the Department’s pain management doctor may be required We encourage Providers and Members to discuss these changes if they are currently taking pain medications.