Coverage of opioid prescriptions for teachers and state employees would be limited under recommendations approved by an advisory panel Monday and aimed at curbing drug dependence and abuse.
The recommendations by the State and Public School Life and Health Insurance Board's Drug Utilization and Evaluation Committee are based on guidelines issued last year by the U.S. Centers for Disease Control and Prevention.
They call for the health plans to limit prescriptions for both acute and chronic pain to a maximum dose of 50 morphine milligram equivalents per day.
According to the CDC, that's equal to about 10 five-milligram tablets of hydrocodone or two 15-milligram tablets of oxycodone a day.
For acute pain, such as following surgery, prescriptions would be limited to a seven-day supply.
Covering more than 30 days' worth of such prescriptions for a patient would require the doctor to submit information about the patient to the health plans' pharmacy consultant, the Evidence-Based Prescription Drug Program at the University of Arkansas for Medical Sciences College of Pharmacy, for approval.
The restrictions would only apply to patients who aren't already using opioids. The committee and board will likely consider trying to reduce the dosages prescribed for some of those already taking opioids within about six months, said Dr. Hank Simmons, the committee chairman.
None of the restrictions would apply to patients who have cancer or who are receiving care for a terminal illness.
"These changes are gong to elicit a lot of strong commentary and probably some good and some bad feeling," Simmons said.
But he noted "there's also a lot of opioid-related death" that the restrictions are aimed at preventing.
According to the CDC, 157 Arkansans died in 2014 of overdoses of opioid pain medications, up from 15 such deaths in 2000.
The health plans spend about $2.6 million a year on opioid prescriptions -- about 2 percent of the plans' total drug spending, said Geri Bemberg, assistant director of the Evidence-Based Prescription Drug Program.
"We're not going at this as a cost-saving method," Bemberg said after the meeting. "It's more public health and really trying to get our population healthier and to better treatments for their pain."
According to a report by the Evidence-Based Prescription Drug Program, 153 health plan members filled at least 12 prescriptions for opioid medications from July through September of 2016.
At least 122 of those members were receiving more than 50 morphine milligram equivalents per day, and at least 93 were receiving 90 or more morphine milligram equivalents per day.
According to the CDC guidelines, doctors should use caution when considering a prescription of more than 50 morphine milligram equivalents per day and should avoid prescriptions of 90 morphine milligram equivalents per day.
The plans cover about 45,000 school employees and 26,000 state employees in addition to retirees, as well as employees' and retirees' spouses and dependents.
The state Medicaid program, which covers more than 1 million Arkansans, is also working to reduce opioid use among program enrollees, said Amy Webb, a spokesman for the Arkansas Department of Human Services.
Starting May 9, Medicaid will limit coverage to 250 morphine milligram equivalents per day for most patients, down from 300, according to a notice the program sent to health care providers.
The program will continue reducing the maximum dosage allowed every six months "until the total daily dose is more closely aligned with the CDC recommendations," according to the notice.
The federal Medicare program, which covers almost 600,000 Arkansans, is also imposing limits on opioid prescriptions, based on the CDC guidelines, starting in 2018.
Metro on 04/04/2017