Appropriate Use of Opioids Program Retired January 2024

January 5, 2024

The Appropriate Use of Opioids program was retired on Jan. 1, 2024. Blue Cross and Blue Shield of Illinois will continue to promote safe and effective use of prescription opioids through an approach that more closely aligns with the Center for Disease Control’s 2022 Guidelines for Prescribing Opioids for Pain, which emphasize flexibility and individualized care. 

BCBSIL’s new approach will remove hard edits – or benefit rejections at the pharmacy counter – and instead be updated to soft edits, which will allow the pharmacy or provider to determine whether to dispense. 

The soft edits are in place to alert the pharmacy if: an opioid naïve member has an opioid prescription that exceeds seven days; or, if a member has exceeded dosage limits and has filled overlapping opioid prescriptions at two or more pharmacies and from two or more providers. 

A member is considered opioid naïve if they don’t have an opioid prescription within the past 60 days, based on pharmacy claims data. Examples of medications targeted by these new standards are opioid agonists like codeine, oxycodone, hydromorphone, morphine and opioid combination products like oxycodone/acetaminophen, and hydrocodone/acetaminophen.

Also new on Jan. 1, 2024, is the Opioids Extended Release Prior Authorization Quantity Limits program with oxycontin as the lone target. Other opioid quantity limits which existed under AUO will continue under Opioids ER PAQL.