Dr Kimberly Lenz on Implementing, Enforcing Appropriate Opioid Prescribing

Kimberly Lenz, PharmD, clinical pharmacy manager, MassHealth/Office of Clinical Affairs, University of Massachusetts Medical School discusses initiatives introduced to implement appropriate opioid prescribing, best practices for enforcing appropriate prescribing, and if current opioid restrictions have reduced utilization.


What initiatives have been introduced to implement appropriate opioid prescribing?   
When you look across both our plan, as well as other plans across the nation, I think the majority of health plans implement dose limits, quantity limits, duplicate restrictions, and things of that nature, but it really is a wide variety of different plans and initiatives that plans use. Other plans, like ours, use a therapeutic class management program where a multidisciplinary team comes together to reach out to prescribers and discuss treatment plans.

What are best practices to enforce appropriate opioid prescribing?
I think most programs end up using prior authorization because inevitably that’s the tool we have to use, but I think the best approach really is using that in combination with that multidisciplinary team, who’s going to work with the provider hand in glove to kind of decide on safe prescribing, as well as what they think is best for the patient.

Have current opioid restrictions decreased opioid utilization?
It’s a great question, and I’m glad you asked that, because we actually just looked at that in our program. So, I can speak directly to our program, and yes it has worked. So, when we looked over the last 15 years, with our partners at the drug utilization review program at UMass Medical School, we did find a sustained decrease in the average daily dose of our patients who were on high doses of opioids after 3 sequential dose reductions. So right now, we have a high dose limit of 120mg of morphine equivalents, and again, over those 15 years we did see sustained decreases.  
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