Washington State Healthcare Authority Announcement:
Healthcare providers should be aware that on October 1, 2017, a new Washington State Health Care Authority (HCA) clinical policy pertaining to opioid prescriptions takes effect for Apple Health (Medicaid), both through managed care organizations and fee-for-service.
We’re writing to make you aware of the policy and to ask you to “save the date” for a one-hour webinar about the policy. The webinar will be offered twice in September. (see below for details)
New policy helps combat opioid crisis
As you are certainly aware, opioid use disorder (misuse and addiction) is a public health crisis in Washington State and across the country.
In October 2016, Governor Inslee issued Executive Order 16-09, marshalling the state’s resources to combat this crisis. These efforts include preventing opioid use disorder as well as treating it.
HCA’s opioid clinical policy is a prevention and patient safety tool. The focus is on acute prescriptions and on the transition from acute to chronic use, since these are critical to reducing long-term opioid use and the risk of developing opioid use disorder.
Medical organizations support
HCA coordinated with the Washington State Medical Association, Washington State Hospital Association, health plan partners, and others in developing the policy, which aligns with recommendations of the Centers for Disease Control, the Washington State Agency Medical Directors Group, and the Bree Collaborative around safe and appropriate opioid prescribing.
Summary of policy requirements
Risk of long-term opioid use goes up with every day’s supply on the initial prescription, and with every refill. By prescribing the lowest effective dose for the shortest time needed, you can help prevent opioid use disorder.
The policy limits the quantity of opioids that can be prescribed to opiate naïve patients for non-cancer pain. The limits for new opioid prescriptions will be:
• No more than 18 doses (approximately a 3-day supply) for patients age 20 or younger.
• No more than 42 doses (approximately a 7-day supply) for patients age 21 or older.
• You can override these limits if you feel this is medically necessary, by typing “Exempt” in the text of the prescription.
At the point of transition from acute to chronic opioid treatment—defined as six weeks of therapy—the policy requires that you attest that you are following best practices for opioid prescribing.
These are listed on the HCA Chronic Opioid Attestation form, which will soon be available online, and include actions such as:
• Checking the Prescription Monitoring Program.
• Informing the patient about the risks of opioid use, and using a pain contract.
Documentation of these practices should be in the chart, but you are not required to submit supporting materials.
For both acute and chronic prescribing, doses are limited to 90 MED per day, except for exemption situations, or if a peer-to-peer consultation confirms medical necessity.
Patients who are undergoing active cancer treatment or who are in hospice, palliative care, or end-of-life care are exempt from these restrictions.
Patients who are already on chronic opioids will be grandfathered under the policy, and will not be subject to these limits or to prior authorization.
The opioid clinical policy is an important step in helping children and adults in Washington avoid opioid use disorder, and supporting safe and effective use of opioids.
I appreciate your engagement with this effort to lower the effects of the opioid crisis in our state.
Daniel S. Lessler, MD
Chief Medical Officer
Health Care Authority
Read the full policy
The full policy is available online at the HCA website.
Online resources available soon
Informational materials about the policy will be available soon, including:
• An online Q&A for providers and pharmacists.
• Detailed scenarios to explain how the policy would be applied in different situations.
• A patient handout.
These materials will be available on the HCA website by the end of August.
About the Health Care Authority (HCA)
The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through Apple Health (Medicaid) and the Public Employees Benefits Board (PEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
For more information, visit the HCA website, where you’ll also find contact information.
If you are a patient looking for information about current opioid prescribing guidelines in the State of Washington, we recommend you go to this page of the Washington State Department of Health website. Please do not call the WRA office, as we are not the appropriate agency to answer your questions.