Common use of Opioid Reduction Strategies Clause in Contracts

Opioid Reduction Strategies. (A) The Contractor shall develop methods to reduce opioid utilization through MME methodology and MED (Morphine Equivalent Dose) cumulative dosing limits. In coordination with the Drug Utilization Review Board and Department FFS pharmacy policy, the Contractor shall apply a prospective drug utilization edits which prevent Enrollees from obtaining additional opioids beyond the MME/MED limit determined by the Department. There will be a separate standard for Enrollees who are opioid naïve and opioid experienced. (B) Opioid naïve Enrollees will have a lower MME/MED threshold than those currently taking an opioid (defined as an individual who has had a claim for an opioid in the last 90 calendar days from the index prescription date). The MME/MED threshold set by the Department for opioid naïve Enrollees will align with CDC standards. (C) Exceptions to the MME/MED requirements can be made for Enrollees with a valid cancer diagnosis or in other unique situations through a prior authorization. (D) The Contractor shall transition opioid experienced Enrollees exceeding the MME/MED dosing limit gradually over time to fall into the limits derived by the Department. (E) The Contractor shall come into compliance with the MME/MED standards established by the Department within 60 calendar days of receipt of a notice of changes to the Department’s established MME/MED standard. (F) The Contractor may utilize an alternative MME/MED standard that aligns with the SUPPORT Act standards upon approval from the Department.

Opioid Reduction Strategies. (A) The Contractor shall develop methods to reduce opioid utilization through MME methodology and MED (Morphine Equivalent Dose) cumulative dosing limits. In coordination with the Drug Utilization Review Board and Department FFS pharmacy policy, the Contractor contractor shall apply a prospective drug utilization edits which prevent Enrollees members from obtaining additional opioids beyond the MME/MED limit determined by the Department. There will be a separate standard for Enrollees members who are opioid naïve and opioid experienced. (B) Opioid Opioid-naïve Enrollees members will have a lower MME/MED threshold than those currently taking an opioid (defined as an individual who has had a claim for an opioid in the last 90 calendar days from the index prescription date). The MME/MED threshold set by the Department for opioid naïve Enrollees members will align with CDC standards. (C) Exceptions to the MME/MED requirements can may be made for Enrollees members with a valid cancer diagnosis or in other unique situations through a prior authorization. (D) The Contractor shall transition opioid experienced Enrollees exceeding the MME/MED dosing limit gradually over time to fall into the limits derived by the Department. (E) The Contractor shall come into compliance with the MME/MED standards established by the Department within 60 calendar days of receipt of a notice of changes to the Department’s established MME/MED standard. (F) The Contractor may utilize an alternative MME/MED standard that aligns with the SUPPORT Act standards upon approval from the Department.

Opioid Reduction Strategies. (A) The Contractor shall develop methods to reduce opioid utilization through MME methodology and MED (Morphine Equivalent Dose) cumulative dosing limits. In coordination with the Drug Utilization Review Board and Department FFS pharmacy policy, the Contractor shall apply a prospective drug utilization edits which prevent Enrollees from obtaining additional opioids beyond the MME/MED limit determined by the Department. There will be a separate standard for Enrollees who are opioid naïve and opioid experienced. (B) Opioid naïve Enrollees will have a lower MME/MED threshold than those currently taking an opioid (defined as an individual who has had a claim Claim for an opioid in the last 90 calendar days from the index prescription date). The MME/MED threshold set by the Department for opioid naïve Enrollees will align with CDC standards. (C) Exceptions to the MME/MED requirements can be made for Enrollees with a valid cancer diagnosis or in other unique situations through a prior authorization. (D) The Contractor shall transition opioid experienced Enrollees exceeding the MME/MED dosing limit gradually over time to fall into the limits derived by the Department. (E) The Contractor shall come into compliance with the MME/MED standards established by the Department within 60 calendar days of receipt of a notice of changes to the Department’s established MME/MED standard. (F) The Contractor may utilize an alternative MME/MED standard that aligns with the SUPPORT Act standards upon approval from the Department.