Health plans should regularly review their formulary policies to ensure they are aligned with best practices and emerging research on dosage, quantity limits, and formulations. Concerns are emerging that policies restricting opioid access for opioid-dependent patients with chronic pain may do harm instead of improve patient safety. Health plans should work with their provider network to understand where policies may create barriers to safer pain management and work quickly to resolve such barriers. In this section we provide examples of health plan communications to providers regarding policy changes as well as clinical guidance from the Centers for Disease Control and Prevention and health plans regarding opioid prescribing and nonpharmacological pain management.
How to Do It
- Align formulary policies with best practices on dosage, quantity limits, formulations, fraud and abuse, etc.
- Understand where current policies may create obstacles to appropriate pain management or cause harm.
- Work with prescribers to determine what modifications may be needed to reduce the risk of unintended consequences.
- Implement and communicate any change.
Health Plan Stories
Kaiser Permanente Southern California
L.A. Care Health Plan
Partnership HealthPlan of California
- Centers for Disease Control and Prevention
- Department of Veterans Affairs: Academic Detailing Service — Pain and Opioid Safety Initiative Materials
- New York Department of Health: Preventing Prescribing Errors (PDF)
- Partnership HealthPlan of California
- San Francisco Health Plan: FAQ Guide for the 7-Day Limit on Initial Opioid Rxs (PDF)
- Rehabilitation Oncology: “Opioids Campaigns’ Impact on Advanced Cancer and Hospice and Palliative Care: An Invited Commentary“
- General Hospital Psychiatry: “Suicidal Ideation and Suicidal Self-Directed Violence Following Clinician-Initiated Prescription Opioid Discontinuation Among Long-Term Opioid Users“
- San Francisco Department of Public Health: Opioid Stewardship and Chronic Pain: A Guide for Primary Care Providers (PDF)