MONTGOMERY, AL (WSFA) - Changes are coming to Blue Cross Blue Shield of Alabama's opioid management strategy.
According to BCBS of Alabama, new requirements will be implemented on April 1 to help decrease the misuse of opioid medications.
The following requirements will be implemented:
- Members will be limited to a seven-day supply for the first time they fill a short-acting opioid medication. If an initial fill is needed for a supply of more than seven days, members may ask their doctor to submit a one-time Prior Authorization (PA). Short-acting opioid medications include Lortab, Vicodin, Percocet, etc.
- Members will be required to obtain a PA for all first-time prescriptions for long-acting opioid medications. These medications include OxyContin and MS Contin.
- Naloxone, the antidote for an opioid overdose, will be available to most members at the generic copay. These include the prefilled syringes and nasal spray.
- Evzio, an auto-injector antidote, will no longer be covered because it is a high-cost drug with the same active chemical ingredient as naloxone. The manufacturer of Evzio has repeatedly increased its prices from $690 in 2014 to $4,500 in 2017. The price of the nasal spray and prefilled syringes are about $80 and $150 per prescription, respectively. As a result, Evzio is now 30-56X the cost of alternative naloxone formulations.
According to BCBS of Alabama, Alabama ranked first in the country in the number of opioid prescriptions per capita in 2015. A recent report showed more than 26 percent of commercial BCBS members in Alabama filled at least one opioid prescription in 2015, and 16 per 1,000 members were diagnosed with opioid use disorder.
BCBS of Alabama officials say they are leaning on guidance from the CDC in implementing these changes.