New United Opioid Coverage Policy

    By: Mishael Azam, Esq. on Feb 08, 2018

    New to Therapy Short-Acting Opioid Supply and Daily Dose Limits for UnitedHealthcare Community Plan and UnitedHealthcare Commercial Plans – Effective March 1, 2018. 

    Beginning March 1, 2018, UnitedHealthcare Community Plan in some states and UnitedHealthcare commercial plans will implement a short-acting opioid supply limit of seven days and less than 50 Morphine Equivalent Dose (MED) per day for patients new to opioid therapy. Requests for opioids beyond these limits will require prior authorization. This change applies to UnitedHealthcare commercial plans and the UnitedHealthcare Community Plan in California, Hawaii, Nevada, New Jersey, New Mexico, New York, Texas and Florida (Healthy Kids).

    How This Affects You and Your Patients Long-term opioid use can begin with the treatment of an acute condition. For this reason, we recommend that you consider prescribing the following: • The lowest effective dose of an immediate-release opioid; and • The minimum quantity of an opioid needed for severe, acute pain that requires an opioid By adhering to these guidelines, you’ll be working to help minimize unnecessary, prolonged opioid use.

    Why We’re Making the Change UnitedHealthcare is dedicated to addressing the opioid crisis and helping people live healthier lives. Studies have shown that chronic opioid use often starts with a patient being prescribed opioids for acute pain. The length and amount of early opioid exposure is associated with a greater risk of becoming a chronic utilizer. For this reason, the Centers for Disease Control and Prevention recommends that when a patient is prescribed opioids for acute pain, they receive the lowest effective dose for no more than the expected duration of pain severe enough to require opioids.


    Released: February 8, 2018, 12:35 pm
    Keywords: Announcements

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