Dual Special Needs Plan Resources > Prescription Coverage Overview > Opioid Safety

Opioid Safety

CareFirst BlueCross BlueShield Advantage DualPrime is dedicated to helping you use opioid pain medications more safely.

To help prevent and combat prescription opioid overuse through improved concurrent Drug utilization review (DUR), CareFirst BlueCross BlueShield Advantage DualPrime will implement opioid safety review at the point of sale (POS), including:

  • Care Coordination Review based on a cumulative morphine milligram equivalent (MME) threshold of 90 MME per day.
    • This review is triggered when the member receives opioid prescriptions from three or more prescribers and the cumulative opioid daily dose is greater than or equal to 90 Morphine Milligram Equivalents (MME).
    • The pharmacist can override this review by consulting with the prescriber to determine the medical necessity of the opioid prescription(s). If the pharmacist is unable or unwilling to override this review, the member, member’s representative and/or prescriber have the option of submitting a coverage determination.
  • A hard safety review to limit initial opioid prescription fills for the treatment of acute pain to no more than a 7-day supply.
    • This review is triggered when an opioid-naïve member fills an opioid prescription for a greater than 7-day supply. Pharmacists can dispense a seven-day supply. The member, member’s representative and/or prescriber have the option of submitting a coverage determination to obtain quantity greater than 7-day supply.
  • A hard 200 MME review
    • This review is triggered when the member receives opioid prescriptions from three or more prescribers and the cumulative opioid daily dose is greater than or equal to 200 Morphine Milligram Equivalents (MME).
    • Prescription may not be filled by the pharmacist without a prior authorization from the plan. The member, member’s representative and/or prescriber will need to submit coverage determination.