CurrentCignaPolicy N/A

Opioids - Morphine Milligram Equivalent (200) Drug Quantity Management Policy

Cigna's Drug Quantity Management policy that governs point-of-sale and utilization management reviews for opioid prescriptions calculated as morphine milligram equivalents (MME), specifically addressing requests that would cause a member's daily opioid dose to exceed 200 MME and providing override/approval criteria for doses >200 up to 600 MME and >600 MME. Applies to listed opioid products and formulations administered under Cigna benefit plans.

Policy Summary

PayerCigna

PolicyOpioids - Morphine Milligram Equivalent (200) Drug Quantity Management Policy

Policy CodePolicy N/A

Change TypeCriteria additions and operational clarifications

Effective Date

Next Review Date

Key ActionIf a prescription will cause the patient's cumulative daily MME to exceed 200, it will reject at point of sale and additional coverage will be determined per the policy; approvals are provided for up to 1 year.

POLICY UPDATE CHANGES

New override criterion added to approve if the patient has sickle cell disease and medication is prescribed by or in consultation with a hematologist.

Criterion added that the need for periodic toxicology testing has been assessed and ordered, if necessary, according to the prescriber.

Fentanyl sublingual tablets were removed from the policy (obsolete).

Fentanyl buccal tablets, nasal solution, sublingual spray were removed from the policy (obsolete).

Methadone tablets for oral suspension, oliceridine injectable, opium/belladonna rectal suppositories were added to the policy document as they rolled into the policy.

A note was added that point-of-sale alerts manage the quantity of opioid product distribution and occur prior to utilization management edits.

200Policy MME intervention threshold (MME/day)

600