November 3, 2014
OHCA Contacts: Jo Kilgore - (405) 522-7474, Jennie Melendez - (405) 522-7404
OHCA Prescribing Changes Aim to Reduce Oklahoma's RX Abuse Problem
The Oklahoma Health Care Authority (OHCA) is now enforcing the first step in its initiative to lower the number of short-acting opioid pain relievers reimbursed by OHCA for SoonerCare (Oklahoma Medicaid) members. While opioid pain relievers play an important role in pain management, their abuse/misuse has become a growing public health issue in Oklahoma and nationwide. According to the 2010 National Survey on Drug Use and Health report, Oklahoma led the nation in non-medical use of painkillers. One in 12 Oklahomans abuse painkillers, such as hydrocodone and oxycodone.
The number of short-acting painkillers that SoonerCare providers can now be reimbursed for per day has changed:
•a quantity limit of eight pills/units per day is now in place for short-acting opioids prescribed for acute pain in need of a 10 day or less supply;
•for chronic pain therapy (supply greater than 10 days), only four pills/units per day are allowed.
These new quantity limits will soon apply to all short-acting painkillers, regardless of the strength or drug. In efforts to allow proper notification and planning, SoonerCare is rolling out these changes over a three-phase timeline. The quantity limits on the most utilized short-acting painkiller (hydrocodone) will take place in January 2015.
“This measure makes sure that our members are receiving clinically appropriate therapy that not only keeps them safe and healthy but also still manages their pain,” said Dr. Nancy Nesser, OHCA Pharmacy director. "For members who really need a high dose of narcotic painkillers to suppress their pain, we hope this change will encourage doctors to prescribe long-acting medications along with short-acting for any breakthrough pain in a safe way.”
Nesser said prescriptions for multiple short-acting painkillers for one patient are a growing problem and not necessary or appropriate. “These changes are all about patient safety and good pain management practices,” said Nesser.
Nesser is part of a team of state leaders who worked on a state plan to reduce prescription drug abuse in Oklahoma. These prescribing changes fall in line with the group’s goals for improved prescribing practice. You can read the entire state plan at takeasprescribed.org.
The Oklahoma Health Care Authority (OHCA) administers Oklahoma’s Medicaid program, known as SoonerCare, and Insure Oklahoma, a premium assistance program funded by tobacco tax revenue. SoonerCare works to improve the health outcomes of Oklahomans by ensuring that medically necessary benefits and services are responsive to the health care needs of our members. Qualifying Oklahomans include low-income children, pregnant women, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. All must meet income guidelines. Insure Oklahoma assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families. OHCA works with our current 818,168 members, our statewide network of 40,161 health care providers and numerous state and local partners to promote responsible health care service utilization, healthy behaviors and improved health outcomes. For more information, visit www.okhca.org or www.insureoklahoma.org.