Opioid and Opioid Combination Medications

Immediately: Providers must obtain prior authorization for all opioid prescriptions except initial 7-day supplies <50 MME/day, cancer pain, or hospice care. Update EMR templates to include required documentation: formal consultative evaluation with diagnosis/etiology, complete medical history of non-opioid therapies tried, active pain management plan, urine drug screening results, PDMP review, substance use disorder risk assessment, and signed patient agreement. Train providers on new requirements as claims will be denied without proper authorization and documentation.