Tuesday, June 12, 2012

BCBS of Mass: Tough New Policy on Opioid Scripts

Blue Cross Blue Shield of Massachusetts is deploying a new policy regarding opioid scripts beginning on July 1. Physicians will be restricted from writing more than a 30 days supply of powerful painkillers without a mandatory review by BCBS.

This is a "first of its kind" policy in commercial/group health (as far as I can tell), though the concept isn't foreign to us in work comp. The issue of prescription drug abuse is pervasive and I'm pleased to see BCBS of MA take this bold step.

Yes, this is going to create some additional administrative burden and expense for physicians. Those concerns are legitimate. Unfortunately, the societal cost of abuse and addiction are sufficiently high that policies such as this are necessary.

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  1. Any suggestions for employers who have old claims that remain open due to chronic pain management and receiving opioids? We have tried contacting the doctor for a response on weaning without success. We feel helpless when the treaters will not concur with utilization reviews/peer reviews.

    1. I assume you're writing from MA... I hope that's the case, because as luck would have it, I was actually sitting next to a Mass. work comp attorney at a conference when I received your comment. I immediately turned to him and asked him to weigh in. Here are his thoughts:

      The burden of proof for reasonable and necessary care rests with the claimant. He recommended sending the physician a certified letter stating that he has 60 (or 90) days to comply with (or at least show progress toward) the recommendations of the IME or peer review. If the doctor still refuses to comply, stop paying for the drugs and get your ducks in a row for a fight (i.e., litigation).

      Granted, this is coming from from an attorney. But he's on the right track. This path is not without risk (you might lose), but you're on the right side of the fight. In fact, were you to NOT take action and your claimant ends up accidentally overdosing, you might find yourself on the hook for death benefits (we now have case law indicating such).

      If you'd like to contact this particular attorney directly, let me know!