Florida’s Medicaid Opioid Prescriptions Dispensing Guidelines: What Are the Rules?

If it is not already apparent, the U.S. is home to a Goliath-sized opioid problem. And this, by the way, is not merely the opinions of a select few but rather a concerning reality documented in voluminous studies. One such study comes from the National Library of Medicine, which revealed some 3 million Americans now have or have previously had an opioid use disorder (OUD). These disorders comprise individuals who abuse commonly prescribed prescription-based opioids, such as OxyContin, Vicodin, and methadone.

While we are on the topic of opioid statistics, it is worth noting that a study published by the Centers for Disease Control and Prevention (CDC) revealed nearly 81,000 Americans died of an opioid-related overdose in 2021. Along with the general public, government organizations have also taken notice of the opioid crisis in the U.S., one being the Centers for Medicare and Medicaid Services (CMS).

How an Opioid Crisis Has Given Rise to New Medicaid Opioid Prescription Dispensing Guidelines in Florida

Studies show the U.S. government, namely the Centers for Medicare and Medicaid Services, is clear-eyed on the opioid problem that has befallen the U.S. and is more ready than ever to do something about it. And that something has come in the form of new Medicaid opioid prescription dispensing guidelines that will, providing things go according to plan, save the lives of countless Americans. They might even help prevent some from ever getting hooked on opioids in the first place.

Those guidelines, published in a 2019 information bulletin, spell out how the CMS plans to reduce the number of prescriptions physicians write for patients as part of a pain management regimen. In Florida, specifically, that means physicians must follow several strict requirements when prescribing opioid-based drugs to patients, some of which include

Prior Authorizations

The CDC states physicians must receive prior approval from a patient’s health insurance provider or a drug utilization review board every six months if any of the following applies:

  • If patients must be on a 90 or higher morphine milligram equivalent (MME) dose of opioids per day
  • If patients must be on a long-acting opioid, such as Fentanyl or Methadone, as part of their pain management regimen

Non-opioid Medications

When appropriate, physicians should prescribe non-opioid medications, such as Cymbalta and Effexor, to combat chronic pain.

Non-pharmacologic options

If applicable, physicians are to recommend non-pharmacologic options, such as acupuncture, physical therapy, and exercise, for coping with chronic or severe pain.

Screening for Substance Use Disorders

Because many people who have a problem with opioids tend to doctor shop as a means of getting more of this powerful drug, the CDC requires that physicians screen patients for a substance use disorder (SUD) before prescribing opioids to them. One screening tool the organization frequently recommends is the Screening, Brief Intervention, and Referral Treatment (SBIRT). According to Medicaid.gov, SBIRT is an evidence-based, comprehensive screening tool developed by the World Health Organization (WHO) in 1982 to help physicians and others in healthcare to evaluate individuals for the misuse of opioids and other substances. According to Medicaid guidelines, physicians should refer individuals identified with an opioid or another substance use disorder to an addiction recovery program rather than supply them with medication.

CDC Guidelines for Prescribing Opioids

The CDC guidelines for prescribing opioids are not too dissimilar from Medicaid guidelines. They are both in place to help lower the number of people falling victim to opioid use disorders each year. The CDC guidelines that are most helpful in this regard include the following:

  • Refusing to prescribe opioids to patients on benzodiazepines
  • Checking the Prescription Drug Monitoring Program (PDMP) while patients are on prescription opioids to minimize the risk of doctor shopping
  • Starting patients on the lowest possible dose of opioids for acute pain and titrating up as needed
  • Ordering routine urine tests to evaluate patients suspected of abusing opioids or other controlled substances
  • Evaluating patients once per month or every three months to see if their opioid dose should be increased, decreased, or stopped

All told, Florida Medicaid guidelines, like CDC guidelines, were created to slow down the opioid crisis in Florida and simultaneously save lives. And according to several studies, including a few from the CDC, they appear to be working. To learn more about either of these guidelines or for help overcoming opioids, consider speaking with one of our associates today at 833-846-5669.