Provider Alert! Uniform Opioid Policy Begins September 1

Attention: All Providers
Effective Date: September 1, 2020

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. 

Call to action: Effective September 1, 2020, the Vendor Drug Program (VDP) will implement a uniform opioid policy to encourage appropriate use and reduce opioid over-prescribing. The opioid policy does not apply to chronic pain, pain treatment as part of cancer care, hospice care, or other end-of-life or palliative care.  If diagnoses are not available in the medical data, exemptions will be handled on a case-by-case basis through the prior authorization process.  

How this impacts providers: A provider may write an opioid prescription for up to 10 days without a refill.  Authorization will be required if the total daily dose of opioids exceeds 90 MME (morphine milligram equivalent) for members that no longer meet the definition of opioid naïve. A tapering plan may be established and approved on a case-by-case basis. If approved, the authorization is good for 6 months. 

Opioid naïve is defined as members who have taken opioids for a duration less than or equal to 7 days in the prior 60-day period. 

MME is an opioid dosage’s equivalency to morphine, and is used to gauge opioid potential overdose risks. Ninety (90) MME per day for commonly prescribed opioids include: 

• 90 mg of hydrocodone (9 tablets of hydrocodone/acetaminophen 10mg/325mg)  
• 60 mg of oxycodone (2 tablets of oxycodone sustained-release 30 mg) 
• 20 mg of methadone (4 tablets of methadone 5 mg)

Next steps for providers: Complete details can be found at:  https://www.txvendordrug.com/about/news/2020/07/uniform-opioid-policy-begins-sept-1 and https://paxpress.txpa.hidinc.com/opcpdg.pdf 

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org. 

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.