Fraud, Waste and Abuse

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Fraud, Waste and Abuse"

Transcription

1 Fraud, Waste and Abuse CT - Fraud Hotline submitted by Connecticut The Fraud Hotline at the Department of Social Services (DSS) is a proactive approach to handling complaints regarding fraud and abuse from the community. Complaints received by the fraud hotline are sent to the pharmacy unit at DSS to determine if patients should be placed into selected review for further action. If an individual is arrested for illegally obtaining controlled substances by fraud &/or possession of narcotics, hallucinogens, etc., they are upon discovery immediately enrolled into the pharmacy lock-in program. Corrective Managed Care Program submitted by Maryland The Corrective Managed Care (CMC) Program has been instituted by the Maryland Medicaid Pharmacy program to monitor and promote appropriate use of controlled substances. The CMC program is particularly concerned with the prescribing practices and utilization of opioids and benzodiazepines. Through a monthly review the state identifies Maryland Medicaid recipients who appear to be on duplicate drug therapy, visit multiple prescribers writing for similar medications, and/or patronize multiple pharmacies. The CMC program shares this information about potential drug misuse with the respective recipient prescribers and pharmacy providers. Physicians and pharmacies are asked to intervene. If despite the best efforts of the prescriber and pharmacy, there still continues to be overutilization of a substance by a recipient, a recipient can be locked-in to a single pharmacy. Under a Lock-In pharmacy agreement, the recipient will be required to fill the related medications at one predetermined pharmacy. Providers can also recommend candidates to the MMPP for lock-in review by using a referral form that is posted on the MMPP website. The CMC Program utilizes the Corrective Managed Care Advisory Committee, which is part of the DUR Board, to assist with the review of individual recipients and help set policy regarding efforts to reduce the potential misuse of controlled substances. The Committee meets just prior to the regular quarterly DUR Board meeting and includes all members of the DUR Board. For those recipients where contact with prescribers through means of intervention letters has not changed behavior, the CMC Advisory Committee reviews each recipient s drug and diagnosis history profile. The Committee then advises the MMPP on recommended corrective action, which may include lock-in, further provider education or continued follow-up. The ultimate goal of

2 locking in a recipient and of the CMC program is to ensure that recipients have access to education they need while reducing the harm associated with over-utilizing controlled substances. Stimulants and Opioid Controls submitted by Delaware As a Drug Utilization Review (DUR) initiative, DMMA focused on the abuse potential of short acting stimulants in the adult population and the encouragement of doctors to write for the lessabuseable longer-acting stimulants. While different adults respond differently to various medications and a full range of medications needs to be available for appropriate treatment, short-acting stimulants are more often misused, abused, or illegally sold or purchased as a drug of abuse. The risks for abuse of prescription and illicit stimulants are elevated among individuals being treated for attention deficient hyperactivity disorder (ADHD) with increased potential for "diversion" due to the possible euphoriant effect or the improvement of study skills. Prescription agents abused most often are those with pharmacokinetic characteristics that provide a rapid rise of dopamine and serotonin while the longer-acting stimulants often have lower abuse potential and less street value. Prior to any interventions or policy changes, 61% percent of the DMMA adult population taking medication for ADHD was on short acting stimulants. Delaware was also very high in terms of per captita dispensing of amphetamines and stimulants. DMMA, on the recommendation of the DUR Board, began to require adult patients to try and fail a long acting ADHD medication before use of a shorter acting one would be approved. Longer acting medications also have the additional advantages of improved compliance, less peak-trough effects that can be seen with twice or thrice daily dosing of immediate-release ADHD medications on dosing, as well as the reduced potential for drug diversion. The DUR board approved an educational letter on the use of ADHD medications and the need for a trial of a long acting medication. The letters were sent to 292 physicians who prescribe CNS stimulants in Delaware as well as medication profiles for their relevant patients, representing 732 clients. A response form was included in the mailing giving the physicians a chance to give us feedback on the following: what they thought of the clinical aspects of intervention, whether the patient had tried and failed a long acting medication before, and if that was why the patient was currently on a short acting stimulant. Within two months of the intervention letter and policy implementation, the percentage of ADHD clients on a short acting stimulant dropped to a total of 42%. This number will continue to decrease in Delaware and further progress will be reported in future DUR reports. New monthly opioid analgesic quantity limits changes were another initiative of DMMA. This policy coincided with the increased focus on the epidemic of prescription drug abuse in Delaware. It was enacted to improve the medical management of pain patients being treated chronically and to ensure checks are available for the patient before any questions of dependence or abuse are raised. While prior authorizations have been in place for some time for long acting medications along with a total quantity limit of 200 units per month for short and long acting

3 narcotics combined, no prior authorization or pain contract was needed for short-acting narcotics that were under the quantity limit. An increasing number of Delaware chronic pain patients were being treated long term with only high dose, high quantity, short-acting medications. This included getting the highly abuseable and diverted oxycodone 15mg and oxycodone 30mg tablets. Individuals with chronic pain who are being treated with frequent doses of short-acting opioids on a regular basis can develop intermittent withdrawal symptoms between doses of medications which may act to increase pain. These patients who increase opioid doses in order to achieve pain relief may actually be treating opioid withdrawal while longer acting opioids have steady serum levels so mini withdrawals or rebound reactions do not occur as often. Without a prior authorization in place there were no requirements by Medicaid to have controls in place to ensure appropriate treatment, evaluation, and monitoring of these patients. In accordance with the Delaware Board of Medical Licensure discipline guidelines, it was recommended that the current policy be tightened to ensure that these drugs were being used appropriately. New quantity limits were put on highly abuseable short acting medications. Clients now are able to get oxycodone immediate release under the following quantity limitations: oxycodone 15mg maximum of 240 capsules a year, oxycodone 20mg maximum of 120 per year and oxycodone 30 mg maximum of 60 capsules per year, after which a prior auth must be submitting including a pain management contract, pain assessment charts, and documentation of pill counts, and random urine screens. For clients currently getting greater quantities, titration to a longacting opioid medication was required with decreased utilization and frequency of the short acting medication or a rotation to a different short-acting opioid for breakthrough pain that would allow for less frequent dosing and utilization. Exceptions were made for clients being treated for cancer and these patients still have these medications available to them without prior authorization if they have an applicable diagnosis on their medical file or have one submitted on the prescription. Since implementation, there has been a transition to more clients being treated for chronic pain with longer acting medications. On prior authorizations submitted, patients were appropriately converted to long acting medications while the shorter acting medications were subsequently decreased and lowered. There has also been a decreased utilization in short acting narcotics in the 5 months since this policy was initiated. Further decreases are expected as people use up their yearly quantity limit of oxycodone and as awareness increases of the issues surrounding use of high doses and high quantities of narcotics chronically. Since this implementation was very successful and because chronic use of opioid medications has risks and should be monitored with a pain contract and urine screens, DMMA also recommended further restrictions on the criteria on short acting narcotics and further tightening up criteria to ensure abuse won t just shift to other drugs. Currently patients can get 2400 units of lower potency narcotics per year without a prior authorization and without any requirement

4 for a drug urine screen or pain contract. For someone with an addictive tendency, by the time the narcotic quantity used exceeds this threshold; it would be too late to prevent the addiction. As such, it was recommended that all short acting opioid analgesics move to a quantity limit of 120 a month with a yearly quantity limit of 720 triggering the need for a prior authorization to be submitted with a pain contract and documentation of drug screens. After 6 months of 120 tablets a month of a short-acting narcotic, a condition would be considered chronic and should be treated with a long-acting narcotic. The Board approved the recommendation and implementation was planned for July Methadone Edits submitted by New Jersey Another innovative solution implemented by DMAHS and Molina Medicaid Solutions demonstrates the informative relationship that can exist between pharmacy claims processing and medical claims history. New Jersey FamilyCare (NJFC)/Medicaid policy limits payment of claims for Methadone to pharmacies based on this drug s intended medical purpose. Pharmacies are eligible to receive NJFC/Medicaid payments for Methadone when this drug is prescribed for pain management. However, when Methadone is prescribed for the treatment of substance abuse, pharmacies are not eligible to receive payment. For the treatment of substance abuse, Methadone is provided by drug treatment centers and is considered a clinic service. To support the Methadone Edit, clinic claims reflecting payments for Methadone are downloaded to the point-of-sale (POS) system. During POS processing, this information is referenced to determine if a conflicting clinic claim for Methadone on or about the service date of the pharmacy claim is found. If a conflicting claim is found, the pharmacy claim is denied for prior authorization. Development of a Prior Authorization Required Process for Medications without prospective DUR edits submitted by Montana In an effort to combat significant medication overuse/abuse and support patient safety, the pharmacy case management program worked with the department to develop and implement a process for a provider-driven PA required process managed through the point-of-sale system. This process is for medications normally not requiring prior authorization and clients for this program are referred on a case-by-case basis. Implementation of a Drug Not Covered Status in the PDCS/X2 system prevents a client from receiving a selected medication or complete therapeutic class of medications each time a claims is submitted, unless a prior authorization is granted per instructions developed by the provider and the case management pharmacist. Currently approximately 200 patients are enrolled and monitored through this program.

5 This has been an effective means to provide a higher level of management for those patients for who even the lock-in program cannot prevent overuse and misuse of medications. This program has been in effect since FFY 2005.

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE SUBJECT EFFECTIVE DATE MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments Pharmacy Service Leesa M. Allen, Deputy Secretary Office of Medical

More information

Arkansas Emergency Department Opioid Prescribing Guidelines

Arkansas Emergency Department Opioid Prescribing Guidelines Arkansas Emergency Department Opioid Prescribing Guidelines 1. One medical provider should provide all opioids to treat a patient s chronic pain. 2. The administration of intravenous and intramuscular

More information

PRESCRIPTION PAINKILLER OVERDOSES

PRESCRIPTION PAINKILLER OVERDOSES IMPACT{ POLICY PRESCRIPTION PAINKILLER OVERDOSES National Center for Injury Prevention and Control Division of Unintentional Injury Prevention What s the Issue? In a period of nine months, a tiny Kentucky

More information

2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov

2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov OHIO AUTOMATED RX REPORTING SYSTEM 2015 REPORT Steven W. Schierholt, Esq. Executive Director www.pharmacy.ohio.gov OHIO AUTOMATED RX REPORTING SYSTEM What is OARRS? To address the growing misuse and diversion

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE September 4, 2015 SUBJECT EFFECTIVE DATE September 9, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Prior Authorization of Opiate Dependence Treatments, Oral Buprenorphine Agents - Pharmacy

More information

KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE

KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 201. GENERAL GOVERNMENT CABINET CHAPTER 9. BOARD OF MEDICAL LICENSURE 201 KAR 9:260. Professional standards for prescribing and dispensing controlled substances.

More information

Protecting your employees, physicians and you.

Protecting your employees, physicians and you. Protecting your employees, physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution - now with real outcomes. Opioids are the most common drugs prescribed in workers

More information

Narcotic drugs used for pain treatment Version 4.3

Narcotic drugs used for pain treatment Version 4.3 Narcotic drugs used for pain treatment Version 4.3 Strategy to restrict the pack sizes or the type of packaging available in public pharmacies. 1. Introduction The document describing the strategy of the

More information

Considerations when Using Controlled Substances to Treat Chronic Pain

Considerations when Using Controlled Substances to Treat Chronic Pain Considerations when Using Controlled Substances to Treat Chronic Pain By Mary-Beth F. Plum, Pharm.D. Impact of Chronic Pain Acute pain is the body s response to environmental dangers, and it helps protect

More information

Kansas Medical Assistance Programs Retrospective Drug Utilization Review Provider Education and Intervention Program

Kansas Medical Assistance Programs Retrospective Drug Utilization Review Provider Education and Intervention Program Program Outcomes Evaluating, Measuring, and Identifying Patient Care Benefits and Cost Reduction Kansas Medical Assistance Programs Retrospective Drug Utilization Review Provider Education and Intervention

More information

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION Effective June 13, 2010 02-313, 02-373, 02-380, 02-383, 02-396 Chapter 21 page 1 02 DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION 313 BOARD OF DENTAL EXAMINERS 373 BOARD OF LICENSURE IN MEDICINE

More information

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District

Massachusetts Substance Abuse Policy and Practices. Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District Massachusetts Substance Abuse Policy and Practices Senator Jennifer L. Flanagan Massachusetts Worcester and Middlesex District November 2014 Substance Abuse and Addiction National and State opioid abuse

More information

Rhode Island Board of Medical Licensure and Discipline

Rhode Island Board of Medical Licensure and Discipline Rhode Island Board of Medical Licensure and Discipline Considerations Regarding Pharmaceutical Stimulant Prescribing for Attention Deficit Disorders (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)

More information

Opioids and the Injured Worker Tools for Successful Outcomes

Opioids and the Injured Worker Tools for Successful Outcomes Opioids and the Injured Worker Tools for Successful Outcomes Tim Pokorney, RPh Director, Clinical Express Scripts Workers' Compensation Division Goals and Objectives Alarming statistics for narcotic utilization,

More information

After seeing a patient on a Diversion Alert installment..

After seeing a patient on a Diversion Alert installment.. After seeing a patient on a Diversion Alert installment.. Recommendations from Dr. James Berry of Mercy Recovery Center OVERVIEW OF DIVERSION Manufacture Distribution Pharmacy Patient End -user OPPORTUNITIES

More information

Opioid Treatment Guidelines. Denis G. Patterson, DO University of Nevada, Reno 7/15/2015

Opioid Treatment Guidelines. Denis G. Patterson, DO University of Nevada, Reno 7/15/2015 Opioid Treatment Guidelines Denis G. Patterson, DO University of Nevada, Reno 7/15/2015 Opioid Treatment Guidelines Opioid Treatment Guidelines Chronic opioid therapy to treat chronic non-cancer pain (CNCP)

More information

Policy for the issue of permits to prescribe Schedule 8 poisons

Policy for the issue of permits to prescribe Schedule 8 poisons Policy for the issue of permits to prescribe Schedule 8 poisons May 2011 Introduction The Victorian Drugs, Poisons and Controlled Substances (DPCS) legislation sets out certain circumstances when a medical

More information

What Every Practitioner Needs to Know About Controlled Substance Prescribing

What Every Practitioner Needs to Know About Controlled Substance Prescribing What Every Practitioner Needs to Know About Controlled Substance Prescribing New York State Department of Health Use of Controlled Substances Controlled substances can be effective in the treatment of

More information

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES

HAWAII BOARD OF MEDICAL EXAMINERS PAIN MANAGEMENT GUIDELINES Pursuant to section 453-1.5, Hawaii Revised Statutes, the Board of Medical Examiners ("Board") has established guidelines for physicians with respect to the care and treatment of patients with severe acute

More information

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling

Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Guidelines for Cancer Pain Management in Substance Misusers Dr Jane Neerkin, Dr Chi-Chi Cheung and Dr Caroline Stirling Patients with a substance misuse history are at increased risk of receiving inadequate

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

Opioid Agreement for Center for Pain Management S.C.

Opioid Agreement for Center for Pain Management S.C. Opioid Agreement for Center for Pain Management S.C. Patient Name: DOB: I am the patient named above. I have agreed to use pain medication as part of my treatment for chronic pain. I understand that these

More information

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians

Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Opioid Prescribing for Chronic Pain: Guidelines for Marin County Clinicians Although prescription pain medications are intended to improve the lives of people with pain, their increased use and misuse

More information

Sedgwick White Paper Narcotic Management

Sedgwick White Paper Narcotic Management Sedgwick White Paper Narcotic Management care management solutions If an employee receives a prescription for narcotics after a workplace injury, it can pose significant safety issues and add unnecessary

More information

Non medical use of prescription medicines existing WHO advice

Non medical use of prescription medicines existing WHO advice Non medical use of prescription medicines existing WHO advice Nicolas Clark Management of Substance Abuse Team WHO, Geneva Vienna, June 2010 clarkn@who.int Medical and Pharmaceutical role Recommendations

More information

Prescription Drug Monitoring Program Center of Excellence at Brandeis

Prescription Drug Monitoring Program Center of Excellence at Brandeis Prescription Drug Monitoring Program Center of Excellence at Brandeis Notes from the Field NF 4.1 Using PDMPs to Improve Medical Care: Washington State s Data Sharing Initiative with Medicaid and Workers

More information

Chronic Pain Management Protocol

Chronic Pain Management Protocol Chronic Pain Management Protocol (Pain lasting >90 days, excluding pain due to malignancy or at the end of life) Prior to initiating opioid medications for a chronic problem, at transition from acute pain

More information

Prior Authorization of buprenophine/naloxone (Suboxone ) or buprenorphine (Subutex )

Prior Authorization of buprenophine/naloxone (Suboxone ) or buprenorphine (Subutex ) June 2010 April 2009 Prior Authorization of buprenophine/naloxone (Suboxone ) or buprenorphine (Subutex ) Effective August 1, West Virginia Medicaid will require prior authorization for all Suboxone and

More information

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008

Drug overdose death rates by state per 100,000 people (2008) SOURCE: National Vital Statistics System, 2008 PRESCRITPION DRUG ABUSE: AN EPIDEMIC What is Addiction? By: Lon R. Hays, M.D., M.B.A. Professor and Chairman Department of Psychiatry University of Kentucky Healthcare Addiction is a primary, chronic disease

More information

Our Mission. How does Colorado Medicaid Work? Objectives

Our Mission. How does Colorado Medicaid Work? Objectives How does Colorado Medicaid Work? Understanding the Delivery of Pharmaceutical Care Cathy Traugott, JD, RPh Client and Clinical Care Office Pharmacy Unit Manager Department of Health Care Policy and Financing

More information

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12

SUBOXONE /VIVITROL WEBINAR. Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 SUBOXONE /VIVITROL WEBINAR Educational Training tool concerning the Non-Methadone Medication Assisted Treatment Policy that is Effective on 1/1/12 WEBINAR INTRODUCTIONS Cynthia Parsons- Program Manager

More information

Sample Patient Agreement Forms

Sample Patient Agreement Forms Sample Patient Agreement Forms Introduction This resource includes two sample patient agreement forms that can be used with patients who are beginning long-term treatment with opioid analgesics or other

More information

Controlled Substance Prescribing Laws, The Prescription Monitoring Program, and Preventing Drug Diversion

Controlled Substance Prescribing Laws, The Prescription Monitoring Program, and Preventing Drug Diversion Controlled Substance Prescribing Laws, The Prescription Monitoring Program, and Preventing Drug Diversion Michael Halse, PharmD PGY1 Resident Pharmacist South County Hospital and Healthcare System Disclosures

More information

Wheeling Ohio County Health Department Emergency Department Opioid Prescribing Guidelines

Wheeling Ohio County Health Department Emergency Department Opioid Prescribing Guidelines In collaboration with medical professionals and community leaders in Ohio County, West Virginia, the Wheeling-Ohio County Health Department has developed the following recommended guidelines and best practices

More information

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN

MANAGEMENT OF CHRONIC NON MALIGNANT PAIN MANAGEMENT OF CHRONIC NON MALIGNANT PAIN Introduction The Manitoba Prescribing Practices Program (MPPP) recognizes the important role served by physicians in relieving pain and suffering and acknowledges

More information

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence

Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Buprenorphine/Naloxone Maintenance Treatment for Opioid Dependence Information for Family Members Family members of patients who have been prescribed buprenorphine/naloxone for treatment of opioid addiction

More information

MEDICAID DRUG SPENDING ON ANTI- ADDICTION MEDICATION AND OPIOID ADDICTION REFRESHER

MEDICAID DRUG SPENDING ON ANTI- ADDICTION MEDICATION AND OPIOID ADDICTION REFRESHER MEDICAID DRUG SPENDING ON ANTI- ADDICTION MEDICATION AND OPIOID ADDICTION REFRESHER TWO PRIMARY ACCESS POINTS Pharmacy Benefit Dispensed by a Pharmacy Billed via the PBM Process (NCPCP) Oversight by Drug

More information

Managing Chronic Pain in Adults with Substance Use Disorders

Managing Chronic Pain in Adults with Substance Use Disorders Question from chapter 1 Managing Chronic Pain in Adults with Substance Use Disorders 1) What is the percent of chronic pain patients who may have addictive disorders? a) 12% b) 22% c) 32% d) 42% 2) Which

More information

Prescribing Standards for Nurse Practitioners (NPs)

Prescribing Standards for Nurse Practitioners (NPs) Prescribing Standards for Nurse Practitioners (NPs) July 2014 Approved by the College and Association of Registered Nurses of Alberta Provincial Council, (July 2014) Permission to reproduce this document

More information

SAFE PAIN MEDICATION PRESCRIBING GUIDELINES

SAFE PAIN MEDICATION PRESCRIBING GUIDELINES Prescription drug abuse has been declared an epidemic by the Centers for Disease Control. According to 2012 San Diego Medical Examiner data, the number one cause of non-natural death is due to drug overdoses

More information

Generics First. Opiod Prescription Monitoring

Generics First. Opiod Prescription Monitoring Access, Quality, Cost: Emergency Department Action Plan to Reduce ED Overutilization The Washington Chapter American College of Emergency Physicians (WA-ACEP), with the support of our fellow health care

More information

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine.

What you should know about treating your pain with opioids. Important information on the safe use of opioid pain medicine. What you should know about treating your pain with opioids Important information on the safe use of opioid pain medicine. If your healthcare provider has determined that opioid therapy is right for you,

More information

Prescription Medication Abuse: Skills for Prevention and Intervention

Prescription Medication Abuse: Skills for Prevention and Intervention Prescription Medication Abuse: Skills for Prevention and Intervention icare Partnership www.icarenc.org James Finch, MD North Carolina Society of Addiction Medicine NC Governor s Institute on Alcohol and

More information

Managed Care Reforms. Ohio Healthcare Policy and Political Update. Physician Ranking Programs SB 121 - Physician Ranking Programs

Managed Care Reforms. Ohio Healthcare Policy and Political Update. Physician Ranking Programs SB 121 - Physician Ranking Programs Ohio Healthcare Policy and Political Update Jeffrey S. Smith, JD, Director, Government Relations Managed Care Reforms Administrative Simplification SB 136 Health Insurance Modernization Act Prohibit unilateral

More information

CDC s Prevention Efforts to Address Prescription Opioid Epidemic

CDC s Prevention Efforts to Address Prescription Opioid Epidemic CDC s Prevention Efforts to Address Prescription Opioid Epidemic Jan Losby, PhD, MSW Lead, Prescription Drug Overdose Health Systems and State Support Team Division of Unintentional Injury Prevention NASBO

More information

Southlake Psychiatry. Suboxone Contract

Southlake Psychiatry. Suboxone Contract Suboxone Contract Thank you for considering Southlake Psychiatry for your Suboxone treatment. Opiate Addiction is a serious condition for which you may find relief with Suboxone treatment. In order to

More information

Support to Primary Care from Derbyshire Substance Misuse Service for prescribed / OTC drug dependence

Support to Primary Care from Derbyshire Substance Misuse Service for prescribed / OTC drug dependence Support to Primary Care from Derbyshire Substance Misuse Service for prescribed / OTC drug dependence SUMMARY 1) Derbyshire Substance misuse service provides Psycho-social treatment interventions for ALL

More information

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen)

Ultram (tramadol), Ultram ER (tramadol extended-release tablets); Conzip (tramadol extended-release capsules), Ultracet (tramadol / acetaminophen) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.35 Subject: Tramadol Acetaminophen Page: 1 of 8 Last Review Date: September 18, 2015 Tramadol Acetaminophen

More information

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Pik-Sai Yung, M.D. Staff Psychiatrist Center for Counseling at Walton Background and Rationale Alprazolam is

More information

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential

More information

Reducing Narcotics Misuse and Abuse in Workers Compensation

Reducing Narcotics Misuse and Abuse in Workers Compensation Reducing Narcotics Misuse and Abuse in Workers Compensation Trusted. Reliable. Sustainable. Page 2 Introduction Narcotics have a long history of being used to therapeutically treat pain resulting from

More information

Opioid Therapy and Physician Communication Guidelines

Opioid Therapy and Physician Communication Guidelines Opioid Therapy and Physician Communication Guidelines i Medication Storage Medication Disposal Prescriber Education Patient Information Contents Best Practice Guidelines Recommendations... 1 Acute Care

More information

PLAN POLICY AND PROCEDURE

PLAN POLICY AND PROCEDURE PLAN POLICY AND PROCEDURE Title: Pharmacy Management Procedure for Pharmaceutical Patient Safety Division(s): Health Services Product Line (check all that apply): All Group HMO Individual HMO PPO POS N/A

More information

Standards. Prescribing Standards for Nurse Practitioners (NPs)

Standards. Prescribing Standards for Nurse Practitioners (NPs) Standards Prescribing Standards for Nurse Practitioners (NPs) July 2014 PRESCRIBING FOR NURSE PRACTITIONERS JULY 2014 i Approved by the College and Association of Registered Nurses of Alberta () Provincial

More information

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER

Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER Strong States, Strong Nation POLICY OPTIONS TO DECREASE RISKS FROM THE USE OF METHADONE AS A PAIN RELIEVER November 17, 2015 Today s Speakers Karmen Hanson, Program Manager, NCSL Cynthia Reilly, Director,

More information

5317 Cherry Lawn Rd, Huntington, WV 25705 Phone: (304) 302-2078 Fax: (304) 302-0279. Welcome

5317 Cherry Lawn Rd, Huntington, WV 25705 Phone: (304) 302-2078 Fax: (304) 302-0279. Welcome 5317 Cherry Lawn Rd, Huntington, WV 25705 Phone: (304) 302-2078 Fax: (304) 302-0279 Welcome Welcome to Starlight Behavioral Health Opiate Dependence program. At Starlight, we believe that addiction is

More information

Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain

Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain Summary Version Utah Department of Health 009 David N. Sundwall, MD Executive Director Robert T. Rolfs, MD, MPH State Epidemiologist

More information

WAC Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer pain.

WAC Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer pain. WAC 246-853-660 Pain management Intent. These rules govern the use of opioids in the treatment of patients for chronic noncancer pain. WAC 246-853-661 Exclusions. The rules adopted under this section do

More information

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. NEW products from the Medicare Learning Network (MLN)

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services. NEW products from the Medicare Learning Network (MLN) Medicare Advantage Outreach and Education Bulletin Anthem Blue Cross Prescription Drug Monitoring Programs Prescription drug abuse and diversion are acute problems in the area of pain management. The Centers

More information

Getting the best result from Opioid medicine. in the management of chronic pain

Getting the best result from Opioid medicine. in the management of chronic pain Getting the best result from Opioid medicine in the management of chronic pain Your doctor has prescribed you opioid medicine to help you manage your chronic pain. This patient information leaflet gives

More information

Guidelines for Use of Controlled Substances for the Treatment of Pain

Guidelines for Use of Controlled Substances for the Treatment of Pain 1.0 Purpose: Use of Controlled Substances for the Treatment of Pain The Physicians Advisory Committee for Controlled Substances of the Medical Society of Delaware supports the Federation of State Medical

More information

ARCHIVED BULLETIN. Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E

ARCHIVED BULLETIN. Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E BULLETIN INTELLIGENCE Product No. 2004-L0424-013 SEPTEMBER 2004 U. S. D E P A R T M E N T O F J U S T I C E NDIC Within the past 2 years buprenorphine a Schedule III drug has been made available for use

More information

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths

UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths UNM Pain Center: Addressing New Mexico s Public Health Crises of Pain, Addiction, and Unintentional Opioid Overdose Deaths Joanna G Katzman, M.D., M.S.P.H Director, UNM Pain Center Associate Professor,

More information

Methadone. Buprenorphine 10/9/2015

Methadone. Buprenorphine 10/9/2015 Medication Assisted Treatment for Opioid Addiction Tanya Hiser, MS, LPC Premier Care of Wisconsin, LLC October 21, 2015 How Did We Get Here? Civil War veterans and women 19th Century physicians cautious

More information

18% Role of Pharmacist-Provided Medication Reviews in Workers Compensation Claims Management. Introduction. Role of the Pharmacist

18% Role of Pharmacist-Provided Medication Reviews in Workers Compensation Claims Management. Introduction. Role of the Pharmacist Role of Pharmacist-Provided Medication Reviews in Workers Compensation Claims Management Benjamin Link, PharmD, RPh Introduction According to information from the National Council on Compensation Insurance

More information

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

More information

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN

ADVISORY OPINION THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF CHRONIC PAIN Janice K. Brewer Governor Arizona State Board of Nursing 4747 North 7 th Street, Suite 200 Phoenix, AZ 85014-3655 Phone (602) 889-5150 Fax - (602) 889-5155 E-Mail: arizona@azbn.gov Home Page: http://www.azbn.gov

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline: CSD - Suboxone Therapeutic Class: Central Nervous System Agents Therapeutic Sub-Class: Analgesics and Antipyretics (Opiate Partial Agonists) Client: County of San

More information

Methadone for Substance Abuse. By: Angela M. Martinez

Methadone for Substance Abuse. By: Angela M. Martinez Methadone for Substance Abuse By: Angela M. Martinez When taken orally once a day, methadone suppresses narcotic withdrawal for between 24 and 36 hours. Because methadone is effective in eliminating withdrawal

More information

Blueprint for Prescriber Continuing Education Program

Blueprint for Prescriber Continuing Education Program CDER Final 10/25/11 Blueprint for Prescriber Continuing Education Program I. Introduction: Why Prescriber Education is Important Health care professionals who prescribe extended-release (ER) and long-acting

More information

Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution.

Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution. TM Protecting your employees, the physicians and you. Opioid abuse is being talked about every day. Modern Medical has a solution. Goals of Opioid Defense Manager TM Opioids are the most common drugs prescribed

More information

PATIENT TREATMENT AGREEMENT

PATIENT TREATMENT AGREEMENT PATIENT TREATMENT AGREEMENT Patient Name: : As a participant in buprenorphine treatment for opioid misuse and dependence, I freely and voluntarily agree to accept this treatment agreement as follows: I

More information

Substance Use: Addressing Addiction and Emerging Issues

Substance Use: Addressing Addiction and Emerging Issues MODULE 6: SUBSTANCE USE: ADDRESSING ADDICTION AND EMERGING ISSUES Substance Use: Addressing Addiction and Emerging Issues Martha C. Romney, RN, MS, JD, MPH Assistant Professor Jefferson School of Population

More information

Opioid overdose can occur when a patient misunderstands the directions

Opioid overdose can occur when a patient misunderstands the directions Facts About Opioid Overdose How Does an Overdose Occur? Opioid overdose can occur when a patient misunderstands the directions for use, accidentally takes an extra dose, or deliberately misuses a prescription

More information

For a Healthier America: Reducing Prescription Drug Misuse and Abuse

For a Healthier America: Reducing Prescription Drug Misuse and Abuse For a Healthier America: Reducing Prescription Drug Misuse and Abuse The misuse and abuse of prescription medicines is a growing public health problem. In addition to the tragic toll on families and communities,

More information

Do You Know Where the Drugs Are Going? Partners in Integrity

Do You Know Where the Drugs Are Going? Partners in Integrity Do You Know Where the Drugs Are Going? Partners in Integrity Objectives At the conclusion of this presentation, participants will be able to: Identify common types of drug diversion activities. List at

More information

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth

Prescription drug abuse trends. Minnesota s Prescription Monitoring Program. Minnesota Rural Health Conference June 25, 2013 Duluth Prescription drug abuse trends Minnesota s Prescription Monitoring Program Carol Falkowski Drug Abuse Dialogues www.drugabusedialogues.com Barbara Carter, Manager MN Board of Pharmacy www.pmp.pharmacy.state.mn.us

More information

Chronic Opioid Use: Comparison of Current Guidelines

Chronic Opioid Use: Comparison of Current Guidelines Western Occupational and Environmental Medical Association Chronic Opioid Use: Comparison of Current Guidelines INTRODUCTION Recent controversies about opioid misuse, including misuse among patients with

More information

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation

A Healthesystems Clinical Analysis. Insidious Incrementalism of Opioid Use in Workers Compensation A Healthesystems Clinical Analysis Insidious Incrementalism of Opioid Use in Workers Compensation Prescription opioid use in the United States has grown significantly over the past 20 years. In 1991, there

More information

Do You Know Where the Drugs Are Going?

Do You Know Where the Drugs Are Going? Do You Know Where the Drugs Are Going? Presentation Objectives At the conclusion of this presentation, participants will be able to: Identify common types of drug diversion activities. List at least four

More information

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain

Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Michigan Guidelines for the Use of Controlled Substances for the Treatment of Pain Section I: Preamble The Michigan Boards of Medicine and Osteopathic Medicine & Surgery recognize that principles of quality

More information

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages

Appendices to Interim Report on the Baltimore Buprenorphine Initiative. Managed Care Organization Information Pages Appendices to Interim Report on the Baltimore Buprenorphine Initiative Appendix A Managed Care Organization Information Pages Appendix B Buprenorphine Online Physician Training Information Packet Appendix

More information

MINNESOTA BOARD OF MEDICAL PRACTICE POLICY FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN

MINNESOTA BOARD OF MEDICAL PRACTICE POLICY FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN Section I: Preamble MINNESOTA BOARD OF MEDICAL PRACTICE POLICY FOR THE USE OF CONTROLLED SUBSTANCES FOR THE TREATMENT OF PAIN The Minnesota Board of Medical Practice ("Board") recognizes that principles

More information

Opioid Treatment Agreement

Opioid Treatment Agreement Opioid Treatment Agreement 1. I understand that my provider and I will work together to find the most appropriate treatment for my chronic pain. I understand the goals of treatment are not to eliminate

More information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,

More information

Blue Rx Clinical Pharmacy Programs SM. Formulating the future of pharmacy. Employer Guide

Blue Rx Clinical Pharmacy Programs SM. Formulating the future of pharmacy. Employer Guide Experience. Wellness. Everywhere. SM Blue Rx Clinical Pharmacy Programs SM Formulating the future of pharmacy Employer Guide Contents Introduction...1 Formulary Management...2 Concurrent Drug Utilization

More information

Drug Testing to Support Pain Management

Drug Testing to Support Pain Management NATIONAL REFERENCE LABORATORY Drug Testing to Support Pain Management 500 Chipeta Way, Salt Lake City, UT 84108 (800) 522-2787 (801) 583-2787 www.aruplab.com www.arupconsult.com ARUP is an enterprise of

More information

Tauto-Mod. Homeopathy for Addictions

Tauto-Mod. Homeopathy for Addictions Homeopathy for Addictions Tauto-Mod Methods and outcomes of the Tauto-Mod prescribing system and an analysis of the addictions homeopathic medication pilot project in 2012. Based on a newly developed prescribing

More information

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15

ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15 ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB

More information

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013

Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Testimony Engrossed House Bill 1101 Department of Human Services Senate Human Services Committee Senator Judy Lee, Chairman February 19, 2013 Chairman Lee, members of the Senate Human Services Committee,

More information

Prescribers required to check PDMP before first prescription for Controled Substances for new patient.

Prescribers required to check PDMP before first prescription for Controled Substances for new patient. State, District, or Territory Alabama Arizona Arkansas Colorado Connecticut Delaware Georgia Guam Criteria for Mandatory Enrollment or Query of PDMP Before renewing an Alabama Controlled Substances Certificate,

More information

Pain Management Regulations Affect More Than Pain Management Specialists January 2012. Of counsel to

Pain Management Regulations Affect More Than Pain Management Specialists January 2012. Of counsel to Pain Management Regulations Affect More Than Pain Management Specialists January 2012 LINDA A. KEEN MSN, JD, LHCRM LAW OFFICE OF LINDA A. KEEN P.A. TALLAHASSEE, FL Of counsel to Pain Management Regulations

More information

Request for Information: Opioid Analgesic Prescriber Education and Training Opportunities to Prevent Opioid Overdose and Opioid Use Disorder

Request for Information: Opioid Analgesic Prescriber Education and Training Opportunities to Prevent Opioid Overdose and Opioid Use Disorder This document is scheduled to be published in the Federal Register on 07/08/2016 and available online at http://federalregister.gov/a/2016-16067, and on FDsys.gov DEPARTMENT OF HEALTH AND HUMAN SERVICES

More information

Education Program for Prescribers and Pharmacists

Education Program for Prescribers and Pharmacists Transmucosal Immediate Release Fentanyl (TIRF) Products Risk Evaluation and Mitigation Strategy (REMS) Education Program for Prescribers and Pharmacists Products Covered Under This Program Abstral (fentanyl)

More information

MARYLAND EMERGENCY DEPARTMENT OPIOID PRESCRIBING GUIDELINES

MARYLAND EMERGENCY DEPARTMENT OPIOID PRESCRIBING GUIDELINES MARYLAND EMERGENCY DEPARTMENT OPIOID PRESCRIBING GUIDELINES 1. Hospitals, in conjunction with Emergency Department personnel, should develop a process to screen for substance misuse that includes services

More information

EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org

EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org EXPLORING NALOXONE UPTAKE AND USE PUBLIC MEETING July 01 02, 2015 Fred Wells Brason II fbrason@projectlazarus.org Disclosures Project Lazarus Zogenix Charitable Contribution 2015 Kaléo Charitable Contribution

More information

MEETING OF THE DRUG SAFETY AND RISK MANAGEMENT ADVISORY COMMITTEE MEETING: RISKS AND BENEFITS OF HYDROCODONE COMBINATION ANALGESIC PRODUCTS

MEETING OF THE DRUG SAFETY AND RISK MANAGEMENT ADVISORY COMMITTEE MEETING: RISKS AND BENEFITS OF HYDROCODONE COMBINATION ANALGESIC PRODUCTS MEETING OF THE DRUG SAFETY AND RISK MANAGEMENT ADVISORY COMMITTEE MEETING: RISKS AND BENEFITS OF HYDROCODONE COMBINATION ANALGESIC PRODUCTS David Gaugh, R.Ph. Senior Vice President for Sciences and Regulatory

More information

A Review of the Impacts of Opiate Use in Ontario: Summary Report

A Review of the Impacts of Opiate Use in Ontario: Summary Report A Review of the Impacts of Opiate Use in Ontario: Summary Report A Provincial Summary Report of the Impacts of the Discontinuation of Oxycontin in Ontario: January to August 2013 December 2013 This report

More information

Treatment of Prescription Opioid Dependence

Treatment of Prescription Opioid Dependence Treatment of Prescription Opioid Dependence Roger D. Weiss, MD Chief, Division of Alcohol and Drug Abuse McLean Hospital, Belmont, MA Professor of Psychiatry, Harvard Medical School, Boston, MA Prescription

More information

Methadone Maintenance Treatment for Opioid Dependence

Methadone Maintenance Treatment for Opioid Dependence COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO P O L I C Y S TAT E M E N T # 2 1 0 Methadone Maintenance Treatment for Opioid Dependence APPROVED BY COUNCIL: PUBLICATION DATE: KEY WORDS: REFERENCE MATERIALS:

More information