Massachusetts Blue Cross to Put Limits on Painkiller Prescriptions

Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, is instituting a policy to reduce prescription drug abuse, by limiting the amount of pain medicine most patients can get without prior approval from the company.

The new policy, which will go into effect July 1, allows patients to fill a 15-day prescription, plus one additional 15-day supply of common painkillers, such as Vicodin and Percocet. Any more refill requests must be reviewed by the company. The patient’s doctor will have to assure that several requirements have been met, such as patient counseling about the risk of developing an addiction to the medication. Future prescriptions will have to be written by only one physician, and filled at the same pharmacy or chain, to curb “doctor shopping,” The Boston Globe reports.

Cancer patients, and those with a terminal illness, will be exempt from the new policy.

The Massachusetts Medical Society says it is concerned about the amount of paperwork the new policy will require. “We don’t want the primary role of physicians to be lost by layers of administrative work,’’ Dr. Lynda Young, President of the Massachusetts Medical Society, told the newspaper. She said the group is willing to work with Blue Cross to make the new program more manageable for doctors.

Dr. John Fallon, Blue Cross’ top physician executive, said the plan balances patients’ need with a way to help curb the oversupply of opioids.

A spokesman for America’s Health Insurance Plans, a national trade group, said he did not know whether any other insurers are using similar policies to stem prescription drug abuse.

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    September 15, 2012 at 2:33 PM

    As a BCBS patient, this new rule is terrible. All it does is hold up your medication, that’s it.

    You can still pay for the medication yourself and walk away with it, thus deterring no one and forcing you to pay. Then you get re-imbursed.

    Their prior-authorization idea is so slow that it will cause people in chronic pain or that need medication changes to suffer while they wait on the bloated bureaucracy to react.

    BCBS shouldn’t be involved with this, at all.

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    Steve Briley

    May 8, 2012 at 5:44 PM

    Is anyone but me getting sick and tired of insurance companies determining the course of my care? Since when do they have the right to determine what medications I should take? I understand that there are some abuses of the system when it comes to getting pain medication but the vast majority of prescribers and those the medication is prescribed to do not abuse or misuse the medication. My fear is that physicians will continue to limit their practice and it will simply get harder and harder for those with chronic pain to get appropriate help.

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