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CareFirst Message to Members

Monday, September 25, 2017   (0 Comments)
Posted by: Alysa Craig
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September 21, 2017

Dear Colleague,

As you are aware, drug overdose and opioid-involved deaths are increasing at an alarming rate. CareFirst BlueCross BlueShield (CareFirst) is committed to helping fight the opioid crisis which is crippling communities across the nation. After reviewing the Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain, we have updated our policies to be consistent with the CDC’s prescribing guidance.

Effective October 1, 2017, certain opioid pain medications covered by our prescription drug benefit plan may be subject to quantity and duration limits. We will provide coverage for up to 90 morphine milligram equivalent (MME) per day of immediate and extended-release opioid prescriptions. Additionally, we will provide coverage for up to a seven-day supply of initial immediate-release opioid prescriptions for patients who have not received an opioid prescription in the last three months. The opioid limits do not apply if a patient has received a medication used to treat cancer under their prescription benefit in the last 365 days.

If the patient requires a higher dosage, or longer duration physicians, dentists and other providers may request a prior authorization through the CareFirst Provider Portal or your electronic prior authorization vender. Please note that if patients fill a prescription for a medication that exceeds the limits, they may have to pay the full cost of the medication.

Together with our pharmacy benefit manager, CVS Caremark, we will continue to review our drug prescribing policies and make changes as needed. If you should have any questions, please contact Brian Pinto, Director of Pharmacy Policy, at We look forward to working with you to help fight opioid addiction.


Arif Khan
Vice President, TCCI Program Oversight
CareFirst BlueCross BlueShield

Daniel Winn, M.D.
Vice President and Senior Medical Director
CareFirst BlueCross BlueShield