MedicaidCoverageHigh impact
Opioid dose limits and forced discontinuation or tapers for members on long-term opioid therapy
Oregon Health Plan·OR · Pain Management, Family Medicine, Internal Medicine +2 more·Plan contract
Effective date
May 15, 2024
We identified it
Jun 20, 2026
Summary
Oregon Health Authority issued guidance prohibiting CCOs from forcing opioid discontinuation or rapid tapers for members on long-term opioid therapy (>6 weeks) without provider attestation of safety. CCOs must allow exceptions to dose limits and ensure coverage is no more restrictive than fee-for-service OHP program standards.
Action Required
Immediately: Review all long-term opioid therapy authorization processes to ensure no forced discontinuation or tapers are mandated without provider safety attestation. Update prior authorization criteria to allow exceptions for members exceeding 90 morphine milligram equivalent daily limits when medically appropriate. Ensure utilization management staff understand that CDC guidelines are not strict standards and individual patient circumstances must be considered.