Opioid use disorder (misuse and addiction) is a national public health crisis. More than 90 Americans die every day from an opioid overdose. Studies show that patients are often prescribed more opioids than they need, and the risk of moving to chronic use rises dramatically with longer initial prescriptions.

Why an opioid policy?

As part of Washington State’s strategy to combat this crisis through prevention as well as treatment, the Health Care Authority (HCA) has created opioid policies for Apple Health (Medicaid) and UMP.

Starting January 2, 2018, the policy limits the number of pills that UMP will cover for members:

• Ages 20 or younger: 18 pills or 90 ml of liquid per prescription (about a three-day supply)
• Ages 21 or older: 42 pills or 210 ml of liquid per prescription (about a week’s supply)

Are there exceptions to the policy?

This policy does not apply to members who are:

• Already receiving ongoing opioid therapy (meaning they have filled at least one opioid prescription per month in three of the last four months).
• Receiving cancer treatment.
• In hospice care, palliative care, or end-of-life care.

Providers can also prescribe amounts above these limits if they determine it is necessary to treat your condition.

Which drugs does the policy cover?

Butorphanol; Codeine; Fentanyl; Hydrocodone; Hydromorphone; Levorphanol; Meperidine; Morphine; Oxycodone; Oxymorphone; Pentazocine; Tapentadol; and Tramadol.

Want to know more?

Read the opioid clinical policy for UMP or our one-page fact sheet. You can also call Washington State Rx Services at 1-888-361-1611 (TRS: 711).