As of July 1, Blue Cross and Blue Shield of Kansas has limited prescriptions for immediate release opioids to a seven-day supply for opioid naïve members. Opioid naïve is defined as a member who has not had a claim for any opioid prescription in the past 60 days. Read the official announcement.
The seven-day fill limit was chosen based on the Center for Disease Control and Prevention guideline that notes acute use of immediate release opioids for more than seven days should rarely be needed.
Other details of the program include:
- Claims with a day supply of seven or less will pay without stopping.
- Claims with a day supply above seven will stop (if no history of an opioid claim with a day supply within the past 60 days) and the pharmacy will receive a message stating prior authorization is required for a supply of more than seven days.
- The pharmacy will have the option to rebill the claim limiting the prescription to a seven-day supply.
- Claims meeting a 60-day look back will pay with no day supply limitation.
- A new prescription may be needed for further fills.
- Existing quantity limits will continue to apply.