Currentblue cross blue shield - louisianaPolicy N/A

Opioid drug coverage and prescribing toolkit

Defines Blue Cross and Blue Shield of Louisiana's 2018 opioid drug coverage policy and accompanying provider toolkit, intended for providers who prescribe opioids to Blue Cross members in Louisiana.

Policy Summary

Payerblue cross blue shield - louisiana

PolicyOpioid drug coverage and prescribing toolkit

Policy CodePolicy N/A

Change TypeNew policy and regulatory alignment (2018)

Effective DateJan 1, 2018

Next Review DateN/A

Key ActionCheck the Louisiana Prescription Monitoring Program before prescribing opioids and every 90 days for ongoing therapy; use the Opioid Prescribing Toolkit for documentation.

SourceLink

POLICY UPDATE CHANGES

Blue Cross implemented a new opioid drug coverage policy and prescriber toolkit in 2018 to reduce opioid risks among members.

References to new state laws (Act 82 and Act 76) that affect prescribing were included to align coverage expectations with regulatory requirements.

122/100LA prescribing rate

7-dayFirst-fill limit (Act 82)

90 daysPMP re-check interval

2018Policy effective year

Coverage Requirements and Limits

Coverage and prescriber obligations

Policy and toolkit govern opioid prescribing and coverage; providers must follow state law and Blue Cross guidance.

Provider requirements: Providers must adhere to state laws (Act 82 and Act 76) including the 7-day limit for first-time opioid fills unless exempt, and the requirement to check the Louisiana Prescription Monitoring Program (PMP) before prescribing and recheck every 90 days if the prescription continues; providers must also follow Blue Cross opioid coverage policy and use the Opioid Prescribing Toolkit for documentation and risk mitigation.

Act 82 exempts patients with certain conditions (for example, cancer or chronic pain) and allows medical-necessity overrides; see full insurer policy and toolkit for details on coverage determinations.

The Louisiana legislature enacted Act 82 (effective Aug. 1, 2017), which establishes a 7-day prescription limit for first-time opioid fills for treatment of pain. The statute explicitly exempts patients with certain conditions — for example, cancer or chronic pain — and permits prescribers to override the limit when medical necessity is documented. These statutory exemptions align with the insurer's coverage approach and should be used when determining whether an initial opioid supply longer than seven days is supported.

Providers should apply the statutory first-fill limit and document any exception or override using the clinical justification and medical-necessity rationale consistent with state law and the Blue Cross Opioid Prescribing Toolkit. When an exemption or override is claimed (for cancer, chronic pain, or other approved medical necessity), ensure the record contains the specific condition, treatment plan, and rationale for exceeding the 7-day limit to support coverage.

Policy Summary

Payerblue cross blue shield - louisiana

PolicyOpioid drug coverage and prescribing toolkit

Policy CodePolicy N/A

Change TypeNew policy and regulatory alignment (2018)

Effective DateJan 1, 2018

Next Review DateN/A

Key ActionCheck the Louisiana Prescription Monitoring Program before prescribing opioids and every 90 days for ongoing therapy; use the Opioid Prescribing Toolkit for documentation.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Toolkit, Documentation, and Operational Requirements

Prior Authorization

Opioid coverage policy and toolkit (see full policy)

Blue Cross implemented a new opioid drug coverage policy in 2018; providers should consult the insurer's Opioid Prescribing Toolkit and coverage policy for the full coverage requirements and any prior authorization processes.

Step Therapy

Step therapy

No step therapy requirements are specified in this document excerpt.

Documentation Required

Use toolkit for documentation

Use the Blue Cross Opioid Prescribing Toolkit materials — including the sample treatment plan outline, patient agreement, and opioid risk assessment tools — when documenting opioid therapy decisions and patient education.

Sample Treatment Plan Outline, Definitions and Agreement
Sample Pain Treatment with Opioid Medications Patient Agreement
Opioid Screening Risk Assessment Tool and Opioid Safety Survey

Denial Risk

PMP check requirement

Providers must check the Louisiana Prescription Monitoring Program (PMP) before prescribing opioids and recheck it every 90 days if the prescription continues; failure to do so could conflict with state law and risk coverage or regulatory action.

Check the PMP before the initial opioid prescription.
Recheck the PMP at least every 90 days for ongoing opioid therapy.

Conservative Management and Patient Agreements

Conservative treatment and use of toolkit materials

Use the toolkit materials to support conservative management and patient agreements.

Toolkit-based conservative care: Before or during opioid therapy, incorporate toolkit resources such as risk assessment tools, sample treatment plans, screening instruments, and patient agreements to document conservative management and informed consent.

Toolkit contents include CDC guidance, opioid screening/risk tools, sample treatment plans and patient agreements, PMP overview, and behavioral health resources; use these materials when documenting opioid therapy decisions and patient education.

State Context and Rationale

Louisiana has among the highest opioid prescribing rates in the U.S., which contributed to legislative action to curb initial opioid exposures and improve monitoring. In response, the state passed two key laws: Act 82, setting a 7-day limit on first-time opioid fills (with defined exemptions), and Act 76, which strengthened the state's Prescription Monitoring Program (PMP) and its use by prescribers.

Act 76 requires providers to check the Louisiana PMP before prescribing an opioid and to recheck it every 90 days for ongoing opioid therapy. Blue Cross implemented an opioid drug coverage policy and an accompanying Opioid Prescribing Toolkit in 2018 to align payer requirements and provider resources with these legislative changes and to reduce opioid-related harms among members.

Key Terms

PMP — Prescription Monitoring Program

TermPrescription Monitoring Program (PMP)

DefinitionA statewide database that doctors and pharmacists can check to review patients' controlled substance dispensing records to identify potential abuse.

PurposeHelps prevent doctor shopping by giving prescribers and pharmacists access to dispensing history.

Where to accessGuidance and account information available at www.pharmacy.la.gov (click 'PMP' Prescription Monitoring Program).