Sharp Health Plan is committed to preventing overuse and protecting patient safety. In 2017, Sharp Health Plan began the opioid cumulative dose program for members using opioid drugs. The purpose of the program is to reduce the likelihood that members
receive unsafe levels of opioid medications. Unsafe opioid levels could be the result of a member receiving multiple prescriptions containing opioids at the same time (drug overlap), or due to a member receiving opioid prescriptions from
multiple prescribers. Our goal is to help protect members from receiving unsafe levels of medication that could cause them harm.
Here’s how the program works:
Sharp Health Plan will apply the appropriate drug utilization review process to ensure access is maintained for needed medications.
If you have any questions about the opioid cumulative dose program, please contact Customer Care at
The Sharp Health Plan claim processing system analyzes prescriptions to ensure that members are not using benzodiazepines and opioids at the same time (concurrently). If concurrent use is detected, the medication will stop processing at the point of sale
and the pharmacist will be required to review the claim(s) for appropriate use. The following messages will be conveyed to the dispensing pharmacy:
The purpose of this safety program is to alert the pharmacist that concurrent use of benzodiazepines and opioids has been detected, which is a potential safety issue. If the pharmacist determines that the prescription claim(s) and/or concurrent use are
appropriate, the pharmacy can override the reject. If the pharmacist determines that the prescription claim(s) and/or concurrent use are not appropriate, the pharmacist will not perform an override. A prior authorization will be required. Prior authorization
requests can be submitted by the prescribing physician to CVS Health at the following numbers:
The prescribing physician should indicate on the prior authorization request form if the member meets any of the following criteria:
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