[Provider] Chronic Narcotic Use Guidelines

[Provider Notification]

Due to increasing concerns regarding the appropriate, safe use of
long-term narcotics, the Pharmacy Unit of the Office of MaineCare
Services will expand the scope of its chronic narcotic prescription
monitoring efforts starting January 1, 2010.  The specific goal is to
promote the widespread adoption of key elements of the existing
standards of care (most notably the joint Rule 11 of the Boards of
Licensure in Medicine and Osteopathy) as they pertain to "new" chronic
narcotic patients.  This effort will require a prior authorization (PA)
for any member who has had 90 days of narcotics in the past 100 days
(and no chronic, sustained narcotic prescriptions in the previous nine
months; i.e.new chronic starters). A PA will not be required for hospice
patients or for those members being actively treated for a life
threatening illness such as AIDS or cancer. It is expected that 100 to
130 MaineCare members per month would meet the criteria requiring such a
PA. Providers will be given thirty days to complete the Prior
Authorization. Pharmacies will be granted overrides to continue
dispensing narcotics during this time period for all affected patients.

The PA will concentrate on determining how thoroughly the following
principles of pain management have been addressed:

*	Confirming an appropriate indication for chronic narcotics
*	Reviewing non-pharmacologic and non-opioid drug treatments
considered and/or tried 
*	Verification that a narcotic/controlled substance contract
exists
*	Reviewing the intended monitoring plan (such as whether Urine
Screens and Random Pill Counts may be appropriate).
*	Verification that Prescription Monitoring Program reports are
used routinely and not misinterpreted

It is anticipated that only a handful (minimum of 1 to maximum of 5) of
Chronic Narcotic Use Prior Authorizations will be required of each
provider. Some patients will require a follow-up PA 3 to 12 months later
to see how well actual monitoring results and contract violations are
handled. Exemptions will be granted quickly once it is clear that
appropriate selection and reevaluation/monitoring of chronic narcotic
patients is occurring. 

Providers may wish to take advantage of a consultation program for
chronic pain jointly sponsored and supported by the Maine Medical
Association and the Maine Board of Licensure in Medicine. This program
provides free, professional consultations. To schedule a visit to your
practice contact Noel Genova directly at noelpac at aol.com or
207-671-9076, or Kellie Miller at kmiller at mainemed..com or 622-3372 ext.
229.

We will soon publish a list of Narcotics that will be included in the
monitoring program.   Please bring your questions, concerns or comments
to the Drug Utilization Review Committee on November 10.  The meeting
begins at 6pm with the open session closing at 7:30 and is located at
the Office of MaineCare Services, 442 Civic Center Dr. Augusta. Or you
can email Jennifer.Palow at maine.gov pharmacy Unit Manager, Office of
MaineCare Services.

Thank you for serving MaineCare members.  

 

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