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.
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.
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.