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As misuse, abuse, and overdose become more common in patients who have been
prescribed narcotic therapy, health care providers and managed care
organizations are faced with the challenge of controlling overutilization. The
most recent data shows that more than 16,000 lives are lost each year due to
opioid-related overdoses. The death toll from accidental overdose has surpassed
that of motor-vehicle accidents, making it the leading cause of death for the
first time in the history of the United States.1
To help facilitate more appropriate usage and prescribing, AmeriHealth will
require prior authorization on all high-dose and high-potency narcotics
effective January 1, 2015.
Prescribing narcotic therapy
AmeriHealth encourages you to keep in mind the following information when
prescribing narcotic therapy to your patients:
- The most commonly abused opioid prescription drugs are: codeine, morphine,
methadone, oxycodone (Oxycontin®), hydrocodone, hydromorphone,
oxymorphone, meperidine, and fentanyl.2
- The recommended maximum daily morphine equivalent dose (MED) should not
exceed 120 mg per day. Above this dose, risks of physical dependence,
tolerance, and adverse reactions must be balanced with the pain relief benefit
as well as functionality and quality of life issues.3
- Consider the balance of long-acting and short-acting
medications. The current recommendation for dosing breakthrough medication is
10 – 15 percent of the daily long-acting dose.4
- Fentanyl patches should not be used in patients without sufficient body
mass. Absorption is decreased in cachetic patients because the drug accumulates
in skeletal muscle and fat and is then slowly released into the blood.
- Ultram® became C-IV as of August 18, 2014.
- Hydrocodone (e.g., Vicodin®, Lortab®) became
C-II on October 6, 2014. These products will no longer be able to be called in
to pharmacies or be refilled. A new hardcopy prescription will need to be
issued for each fill.
When additional help is needed, providers should instruct patients to contact
their mental health/substance abuse services provider. Members with Magellan
Behavioral Health, Inc. coverage can call
1-800-424-4238.
Look for more information on prescribing narcotic therapy in future editions
of Partners in Health UpdateSM.
1 Pennsylvania Guidelines on the Use of
Opioids to Treat Chronic Noncancer Pain. Pennsylvania Medical Society.
2www.drugabuse.gov. National Institute of Drug
Abuse.
3 Franklin, Gary M. Opioids for chronic noncancer pain: A position
paper of the American Academy of Neurology. Neurology 2014; 83;
1277-1284.
4 McPherson, Mary Lynn. Demystifying Opioid Conversion Calculations:
A Guide for Effective Dosing.
Magellan Behavioral Health, Inc. manages mental health and substance abuse
benefits for most AmeriHealth members.
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