Thanks to many of you who have helped further the message of the Lift the Label Campaign. As a reminder, Lift the Label aims to remove damaging labels and stigmas that prevent those with opioid addiction from seeking effective treatment.

The Department continues to work with our partners to make actionable policy changes to help address the opioid crisis.

As you may recall, we have implemented several policies over the past two years which have resulted in a 30 percent reduction in the number of pills prescribed. These included a policy to limit prescriptions for people who are naive to opioids to seven days at a time. Additionally, prescriptions exceeding 21 days require a prior authorization, and, in some cases, a review by a pain specialist. The Department implemented this policy in response to an identified correlation between days supply of initial prescription for an opioid and continued opioid use.

Effective November 15, 2018, there will be a four-day limit for opioid prescriptions after a dental procedure. The Department has been working on the development of this policy with dental provider and community partners. On the same day, the Department will further reduce the total allowable daily Morphine Milligram Equivalents (MME) from 250 to 200. When this calculation exceeds the 200 MME limit, prior authorizations will be required, and processes will be set in motion to allow time for the prescriber to begin working with the member to safely taper their opioid doses down while ensuring adequate pain control is maintained. As with the current MME policy, exceptions will be identified for certain cases where chronic pain management exceeding these limitations may be needed.

You can learn more about the fight against opioid addiction in Colorado by visiting the Colorado Consortium for Prescription Drug Abuse Prevention. For more information about how the Department is addressing opioid addiction, see our Opioid Use in Colorado Overview and the Department's Opioid Resource web page.

 

Thanks for your partnership on this important issue.

Due to recent questions, the Department would like to provide additional clarification about citizenship and identity (DRA) document requirements.

 

Effective May 30, 2018, Colorado Medical Assistance eligibility regulations were updated, stating that citizenship and identity documents may be submitted as: originals, certified copies, photocopies, faxes, scans or other copies.

 

As a reminder, types of documents that can be accepted to verify citizenship and identity have not changed. If an original or certified copy is submitted, please continue to follow the policy and process to certify the original and return the document to the member.

 

Eligibility staff can use the following documents, updated in May 2018 to reflect the rule change:

 

DRA Desk Aid - Citizenship and Identity Requirements

 

DRA FAQs - Citizenship and Identity Documents Frequently Asked Questions

 

For more information, contact [email protected].

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Official Open Enrollment Dates for 2019 are November 1, 2018 - January 15, 2019. 

Counties can order free materials from the  Connect for Health Colorado online store . Connect for Health Colorado covers all costs including shipping. 

Users will create an account and then can choose materials such as brochures, posters, and application checklists. 

For more information, contact Jessica Smith.

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Smoking cessation medications are a covered benefit for all Health First Colorado members, though some of these medications currently require prior authorization approval for coverage.  

As part of continued efforts to help members that are ready to stop smoking or tobacco use, all prescriptions for smoking cessation medications will be covered without a prior authorization. These medications include varenicline (Chantix®), bupropion (Zyban®), nicotine patch, nicotine gum, nicotine lozenge, nicotine inhaler and nicotine spray.  This change is scheduled to go into effect on November 1, 2018.

Also starting on November 1, 2018, Health First Colorado will begin enrolling pharmacists as prescribers and will start covering prescriptions for over-the-counter smoking cessation medications written by enrolled pharmacists as part of the member's pharmacy benefit.  Smoking cessation medications that will be covered with a pharmacist's prescription will include nicotine patches, nicotine gum, and nicotine lozenges. 

For more information on current coverage for smoking cessation medications, visit Health First Colorado Appendix P. 

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The next iteration of the Accountable Care Collaborative (ACC) began July 1, 2018. As a reminder, the Department has published resources and guidance for providers, members, and other interested parties on CO.gov/HCPF/ACCPhase2.

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A new prescription opioid policy will be implemented on November 15, 2018 limiting the total days allowable for dental prescriptions for short-acting opioids to four days per prescription fill and limiting the total quantity for four-day dental prescriptions to 24 tablets or capsules. The policy will allow members to receive up to three four-day dental opioid prescription fills, and the fourth dental opioid prescription fill will require the member's dentist to complete a prior authorization. 

Members undergoing more complex dental procedures such as major orofacial surgery may have their dentist complete the prior authorization and approval may be placed to allow coverage for additional dental opioid prescription fills for up to a seven day supply (and up to 56 tablets or capsules).

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Effective November 1, 2018, pharmacists can enroll with the Department and once enrolled they can prescribe specified over-the-counter products. The drugs:

• Must be prescribed consistent with the Pharmacist OTC Prescriptive Authority list.
• Must follow the Board of Pharmacy Rules outlined in 3CCR 719-1.
• Must follow the Department's Rules outlined in 10 CCR 2505-10, 8.800.

Administering Vaccines

Effective November 1, 2018, pharmacists can enroll with the Department and once enrolled can administer specific vaccinations in a pharmacy (the specific vaccinations are outlined near the bottom of the page). Pharmacists must:

1. Follow the Board of Pharmacy Rules outlined in 3CCR 719-1, 19.00.00.
2. Render vaccinations consistent with the Pharmacist Vaccination list.

Administering Vivitrol

Effective January 1, 2019, the Department plans to implement HB 18-1007, which stipulates that if a pharmacy has entered into a collaborative practice agreement with one or more physicians for the purposes of administering vivitrol, that the pharmacy where the injection is administered shall receive reimbursement when a pharmacist administers it.

For more information, or to learn how to become a Health First Colorado pharmacist, visit our website. 

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