In move to curb addiction, Washington Apple Health limits opioid prescriptions

In an effort to curb addiction to prescription drugs, Washington’s Health Care Authority will limit the quantity of opioids that doctors can prescribe to Medicaid patients starting Nov. 1.

Under the new policy, Washington Apple Health patients under age 20 can get a maximum of 18 tablets or capsules of an opioid. Older patients can get up to 42 tablets or capsules, roughly a one-week supply.

Cancer patients in hospice, palliative, or end-of-life care are exempt, and patients who have filled long-term opioid prescriptions in the last 120 days will be grandfathered in.

About 700 Washingtonians per year die from overdoses involving opioids, often in combination with other drugs. That number has risen in recent years.

“This is a public health crisis, affecting communities and families around Washington and the nation,” said Dr. Dan Lessler, chief medical officer for HCA, in a news release. “Risk of long-term opioid use goes up with every day’s supply on the initial prescription, and with every refill.”

The new rules are based on research published by the Centers for Disease Control showing the likelihood of using opioids long-term increases dramatically with longer initial prescriptions, particularly over five days. They follow CDC guidelines for opioid prescriptions.

The move is also designed to limit the amount of unused opioids out in the community, Lesser said.

Doctors can override the rules by writing “exempt” when prescribing, and can transition patients to long-term opioid use after six weeks, provided they follow best practices. Those include discussing the risks of addiction with patients and using a pain management contract.

The HCA plans to implement an opioid policy for members of the public employee benefits board, a state self-insured plan, in early 2018.