Drug Management Program (DMP) and Opioids

Drug Management Program (DMP) and Opioids

Due to an opioid epidemic across the country, the Centers for Medicare and Medicaid (CMS) have implemented Opioid Utilization Policy programs and oversight of opioid prescriptions dispensed at retail pharmacies. These new safety alerts apply to Blue Cross® Blue Shield® of Arizona members with a Medicare Part D prescription drug benefit and, by working with providers who prescribe these medications, are designed to address the issue of overutilization regarding our nation’s opioid epidemic to promote safe and responsible pain management.

Programs on Drug Safety and Managing Medications

According to the U.S. Department of Health and Human Services, “increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.” Pain relievers such as oxycodone, hydrocodone, codeine, and morphine can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose, and death.

These risks increase the higher the dose you take, or the longer you use these pain medications, even if you take them as prescribed. Your risks also increase if you take certain other medications, like benzodiazepines (commonly used for anxiety and sleep), or get opioids from multiple doctors and pharmacies. Taking more than the required dose can create a dependency (the more you take, the more your body needs to address pain), taking medication not prescribed for you, or attempting to obtain prescriptions from different providers could be indications of being at risk for medication misuse.

BCBSAZ is committed to working with providers to ensure the prescribing of opioids is safe and effective for our members. We have a Drug Management Program (DMP) that can help make sure our members safely use their prescription opioid medications, or other medications that are frequently abused. If you use opioid medications that you get from several doctors or pharmacies, we may talk to your doctors to make sure your use is appropriate and medically necessary. Working with your doctors, if we decide you are at risk for misusing or abusing your opioid or benzodiazepine medications, we may limit how you can get those medications. The limitations may be:

  • Requiring you to get all your opioid or benzodiazepine medications from one pharmacy
  • Requiring you to get all your opioid or benzodiazepine medications from one doctor
  • Limiting the amount of opioid or benzodiazepine medications we will cover for you

If we decide that one or more of these limitations should apply to you, we will send you a letter in advance. The letter will have information explaining the terms of the limitations we think should apply to you. You will also have an opportunity to tell us which doctors or pharmacies you prefer to use. If you think we made a mistake or you disagree with our determination that you are at-risk for prescription drug abuse or the limitation, you and your prescriber have the right to ask us for an appeal. See Chapter 9 in the Evidence of Coverage (EOC) for information about how to ask for an appeal.

The DMP may not apply to you if you have certain medical conditions, such as cancer, or you are receiving hospice care or live in a long-term care facility.

What Are Safety Alerts?

The new CMS policy aims to balance addressing opioid overuse without a negative impact on the patient-doctor relationship, preserving access to medically necessary drug regimens, and reducing the potential for unintended consequences.

Prescribers and pharmacists will conduct additional safety review to determine if a member’s opioid use is appropriate and medically necessary.

If a prescription or claim is denied, it may require the prescriber to submit a Prior Authorization (PA).

What Can You Do?

As older adults, changes in body composition and metabolism, as well as other medications you may be taking, can affect how your body processes these strong and potentially addicting drugs. While many people can take their opioid or benzodiazepine prescriptions without becoming addicted and have been able to effectively manage their acute pain (lasting less than 90 days) or chronic pain (over 3-6 months and beyond), others may have a different outcome.

As you take opioid or benzodiazepine medication, it is important for you to communicate often with your doctor about the nature of your pain, how the medication may or may not be working for you, as well as side-effects you may be experiencing since starting the medication. If you feel you are becoming addicted to your pain medication, notify your doctor immediately.

What are other options to treat pain?

Opioid medications are not the only effective painkillers available to you. We encourage you to talk with your doctor about all your pain treatment options, including whether taking an opioid medication is right for you. You might be able to take other medications or do other things to help manage your pain with less risk. What works best is different for each patient. Here are other non-opioid drug options that should be discussed with your doctor to see if they are worth trying.

  • Acetaminophen - the active ingredient in Tylenol, can be purchased without a prescription. Although acetaminophen isn’t an anti-inflammatory it is good at relieving headaches, back pain, fevers and osteoarthritis.

    Warning - Talk to your doctor or pharmacist about how much to take because acetaminophen can lead to liver damage if you take too much.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – the active ingredient in ibuprofen, naproxen, and aspirin or brands like Advil, Motrin, and Aleve are available without a prescription but there are also prescription only versions. NSAIDs also come in gels and creams. These can help with joint pain or in a specific area of the body. NSAIDs can reduce a fever and inflammation so they are a good choice for mild to moderate pain caused by sprains, headaches, and arthritis. Also can be taken with acetaminophen for additional pain relief, which can lower the need for opioid painkillers.

    Warning – NSAIDs can cause heartburn, stomach ulcers, gut bleeding, and kidney damage, and can also increase the risk of heart disease and stroke. Do not take long term.

  • Antidepressants - some antidepressants, even at low doses, can treat pain caused by damaged nerves. Antidepressants can also relieve symptoms of depression that can exist with persistent pain, and help with difficulty sleeping too. You will need a prescription for an antidepressant so talk to your doctor to see if this drug therapy might be right for you.

There are non-drug options available that deserve a discussion with your doctor. Depending on your type of pain, consider these options to help reduce your pain as well as your need for any drug therapy.

Some examples include*:

  • Exercise
  • Physical therapy
  • Acupuncture
  • Chiropractic therapy
  • Cognitive behavioral therapy
  • Biofeedback
  • Relaxation therapy
  • Transcutaneous electrical nerve stimulation (TENS)

*These are examples and may not be covered by all plans. Check your benefits at www.azbluemedicare.com to determine if covered by your plan.

If you are suffering with pain always try non-drug treatments first. If you and your doctor feel you need drug therapy, take as little as possible of the drug. There are few situations when it is necessary to take NSAIDs or opioids long term. For more information on safe and effective pain management, visit CDC.gov/drugoverdose/patients/index.html.

How do I safely dispose of my unused medications?

Unused medications should be disposed of as soon as possible if it is no longer needed. Flushing it or dumping down a drain is not a good way to dispose of medication because it can end up in local lakes and rivers.

Here are some great ways to discard medication you no longer need:

  • Medication “Take-Back” Programs - Take-back programs allow the public to bring unused drugs to a central location for proper disposal. Call your local government’s trash and recycling service to see if a program is available.
  • The DEA allows you to mail back unused prescription medications to pharmacies and other authorized sites using packages made available at pharmacies and other locations. Most states have agency collection boxes overseen by law enforcement or pharmacies. Call the DEA’s Registration Call Center to find box locations or other disposal sites: 1–800–882–9539, or go to https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ or www.deadiversion.usdoj.gov/drug_disposal/index.html.
  • Community coalitions and law enforcement in your area may sponsor “medication take-back events” periodically.
  • Disposal in Household Trash - If the above programs are not available in your area, place the drugs in the trash by following these steps:
    1. Remove them from their original containers and conceal or remove any personal information, including the Rx number, from the container.
    2. Mix the medications with something inedible, such as coffee grounds or kitty litter.
    3. Place the empty container and the mixture in a sealed bag or empty can.

For more information, go to:

https://azdhs.gov/gis/rx-drop-off-locations/index.php (AZ Rx Drug Drop-Off Locations)




Additional National and State Resources

If you or a loved one are experiencing challenges with pain medications, national and state resources are available to learn more about opioids, benzodiazepines, or other potentially addicting drugs.

Mobilize AZ - Blue Cross Blue Shield of Arizona Invests $10 Million in Fight Against Opioid Misuse and Substance Abuse Disorder


Arizona Department of Health Services - Providing ‘real time’ data and statistics

National Public Radio (NPR) - Opioids can Derail the Lives of Older People, Too

Substance Abuse and Mental Health Services Administration - Why Do Adults Misuse Prescription Drugs?

The Washington Post - Unseen face of the opioid epidemic: drug abuse among the elderly grows

U.S. Department of Health and Human Services

What is the U.S. Opioid Epidemic?

What are Opioids?