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Title:

Narcotic Quantity Limit Overrides

Number:

OKRX 0418201

Effective Date:

07/01/04

Legislation:

OK Clinical Policy Origination Date: 09/01/04, 10/06/06

Contract:

Check all contract provisions.

Coverage:

Blue Cross Blue Shield of Oklahoma pharmacy programs place quantity limits on certain narcotic medications to promote appropriate utilization and limit potential adverse effects. This quantity limit may be overridden when medical necessity criteria are met.

Description:

Narcotic quantity limits may be overridden for a period of one year if any of the following criteria are met:

-Diagnosis of cancer

-Written recommendation by a board-certified or fellowship trained pain management specialist or board certified sub-specialist appropriate for the diagnosis.

Although prescription medications have dosage recommendations that are studied by the manufacturer and approved by the FDA, certain medications, with proper dose titration, do not have an established maximum dose. Some patients require doses beyond the recommended limits in order to achieve optimal pain control.

References:

Skaer TL. Transdermal opioids for cancer pain.
Health Qual Life Outcomes. 2006 Mar 31; 4:24. Review.

Davis MP. Acute pain in advanced cancer: an opioid dosing strategy and illustration.
Am J Hosp Palliat Care. 2004 Jan-Feb; 21(1):47-50.

McCarberg BH, Barkin RL. Long-acting opioids for chronic pain: pharmacotherapeutic opportunities to enhance compliance, quality of life, and analgesia.
Am J Ther. 2001 May-Jun; 8(3):181-6. Review.