Starting January 1, 2019, new safety point-of-sale edits will be implemented to help decrease the risk of opioid overutilization and overdose death.
For All Lines of Business
L.A. Care Covered, L.A. Care Covered Direct, PASC-SEIU Homecare Workers Health Care Plan, Medi-Cal and Cal MediConnect
Brief Description of Point-of-Sale Edits
- Soft Reject - when prescription opioids are filled at the pharmacy, the pharmacist must perform an additional safety check and sign-off when:
- Hard Reject - when prescription opioids are filled at the pharmacy, the pharmacist must call Navitus to receive an approval to complete the fill when:
For the Cal Mediconnect Line of Business Only
Brief Description of Point-of-Sale Edit
- Hard Reject - when prescription opioids are filled at the pharmacy, the pharmacist must call Navitus to receive an approval to complete the fill when:
Exclusions
The following member populations are excluded from the Soft and Hard Edits:
- hospice
- cancer
- long term care
- palliative care
Proactive Steps
Take proactive steps when prescribing opioids:
- Educate patients and staff on opioid safety measures.
- Co-prescribe naloxone with opioids.
- Establish realistic treatment goals with patients for pain and function.
- Follow state and federal requirements.
- Submit a Prior Authorization (PA) request when clinically appropriate doses exceed health plan quantity limits.
- Communicate with dispensing pharmacists as necessary when treatments exceed point of sale safety edits.