Opioid/benzodiazepine concurrent use program for Covered California members
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:
- Evaluate patient taking benzodiazepine and opioid concurrently.
- Claim conflicts in therapy with member history.
- The dispensing pharmacist will be given the opportunity to override the rejection.
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:
- Cancer diagnosis
- Hospice patient
- Patient is receiving palliative care