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One way to reduce the impact of the opioid epidemic is to ensure that people have access to safe therapies that treat opioid use disorder. To that end, Blue Cross NC is taking steps to help patients get the care they need while ensuring their safety.

On Nov. 1, we stopped requiring doctors to get approval before administering some forms of medication-assisted treatment, or MAT. MAT involves giving patients safe doses of certain drugs to help with their withdrawal symptoms.

The changes in our policy recognize that there’s no one-size-fits-all treatment for those struggling to overcome an opioid dependency. Many steps may be needed, such as counseling, pain management therapies and MAT.

Ensuring Patient Safety

Until recently, Blue Cross NC required doctors to get approval before administering MAT. The reason behind this policy was simple: The drugs used with MAT can interact dangerously with other drugs or may be used in inappropriate situations. The prior authorization requirement helped us make sure our members got the medications they need – and didn’t get ones that could cause them harm.

In reviewing our policy, we found that providers were delivering this therapy appropriately in the vast majority of cases. This provided us an opportunity to remove prior authorization and any delay in our members starting therapy.

We wanted to make sure people received the care they need, while also ensuring they were protected. To help achieve this goal, we developed new and better tools to monitor drugs prescribed for MAT. These tools are allowing us to identify inappropriate use and contact the provider if we feel that there is a potential issue.  

An Updated Policy

After reviewing these new tools and strategies, and conducting in-depth analysis which found the vast majority of our providers are complying with best practices, we made the decision to no longer require prior authorization on our preferred MAT medications: Suboxone films, Buprenophine/naloxone tablets, and Buprenophine.

These three products represent more than 96 percent of all buprenorphine-based MAT that we authorized in the past year.

Safeguards Still in Place

To ensure safe and effective use, these safeguards will remain in place:

  • Quantity limitations still apply to help ensure safe dosing
  • Five-day quantity limit on buprenorphine (Buprenophine) as a stand-alone product
  • Members with an allergy to naloxone or who are pregnant or breastfeeding will need authorization for continued buprenorphine without naloxone beyond five days
  • Non-preferred MAT products will remain on prior authorization

Our goal is to make sure that our members and their doctors have access to safe, medically appropriate treatments such as MAT.

For more information about what’s covered in your plan, please check your benefits booklet or call the customer service number on the back of your Blue Cross NC identification card. 

Estay Greene

About Estay Greene

Estay Greene, PharmD, is vice president of pharmacy services at Blue Cross and Blue Shield of North Carolina. He is responsible for leading the company’s prescription drug programs and benefits. Before joining BCBSNC, he was director of pharmacy benefits for the Cleveland Clinic/Cleveland Health Network in Ohio.

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