Maryland Medicaid’s multifaceted approach to tackling the trends of opioid misuse, dependence and overdose


In support of Governor Larry Hogan’s Heroin and Opioid Prevention, Treatment, and Enforcement Initiative, Maryland Medicaid is partnering with our HealthChoice Managed Care Organizations (MCOs) to implement new policies focused on improving the opioid prescribing process in Medicaid, in the effort to reduce opioid misuse, dependence, overdose and death. These policies were developed in collaboration with our MCO partners and will require providers to complete prior authorization for: (1) any opioid prescriptions deemed a high dose; and (2) any long-acting opioids, including fentanyl.


The policy changes will be in place by July 1, 2017, for both Medicaid fee-for-service and HealthChoice MCOs. They aim:


·         To prevent medical and non-medical opioid use, dependence and substance use disorder from developing;

·         To identify and to treat opioid dependence early in the course of the disease, if it occurs;

·         To prevent overdose deaths, medical complications, psychosocial deterioration, transition to injection drug use and injection-related disease;

·         To identify and reach out to providers who do not follow standard practice; and

·         To use data to monitor and evaluate activates.


With more than 20 percent of Marylanders enrolled in the HealthChoice program and six of eight MCOs being integrated provider and payer networks, Maryland Medicaid’s HealthChoice managed care organizations are a natural, critical partner in helping achieve maximum results.


According to the Centers for Disease Control and Prevention (CDC), inappropriate prescribing practices and opioid prescribing rates are substantially higher among Medicaid patients than among privately insured patients. In one study based on 2010 data, 40 percent of Medicaid participants with prescriptions for pain relievers had at least one indicator of potentially inappropriate use or of overlapping prescriptions for pain relievers, of overlapping pain relievers and benzodiazepine, or of extended-release prescription pain relievers for acute pain and of high daily doses.


In addition to prior-authorization requirements, Medicaid also is encouraging providers:

·         To consider non-opioids as first-line treatment for chronic pain;

·         To offer naloxone to patients who meet certain risk factors;

·         To conduct thorough substance use disorder screening prior to prescribing opioids;

·         To refer patients to treatment that are identified as having a substance use disorder; and

·         To use the Department’s Prescription Drug Monitoring Program for all Controlled Dangerous Substance prescriptions.


According to the CDC almost 2 million Americans abused or were dependent upon prescription opioids in 2014. As many as one in four people who receive prescription opioids long term for noncancer pain in primary care settings struggles with addiction.


Maryland’s reform on opioid-prescribing process follows approval from the U.S. Centers for Medicare and Medicaid Services for Maryland Medicaid’s Waiver renewal for its HealthChoice program. This is the first time the state was able to negotiate a five-year agreement with the federal government.


The waiver will take effect January 1, 2017, and includes several innovative initiatives that will allow Medicaid to pay for substance use services, and will allow local jurisdictions to address the social determinants of health for their most vulnerable individuals through locally managed programs. Key components of this agreement include:

·         Residential treatment for substance use disorders;

·         Expanded dental care coverage for former foster care youths;

·         A community health pilot program;

·         Evidence-based home visiting for children and pregnant women;

·         Increased community services program; and

·         Presumptive eligibility for individuals leaving jail or prison.


Prior to Maryland Medicaid announcing its own opioid-prescribing guidance, the CDC released their own guidance regarding the prescription of opioids for chronic pain in March of 2016. The CDC’s guidance became the theme of the Maryland Medicaid Pharmacy Program’s annual conference:"Updates in pain management: A focus on effective pain management and new safety concerns." 


By bringing together attendees to review the CDC clinical guidelines, provide an overview of Maryland’s opioid-use concerns, and discuss challenging pain management cases, the webinar increased provider’s knowledge of safe and effective opioid prescribing methods that can be utilized on a daily basis. The conference was recorded and can be found on our website.​

Additional conference resources include the postcard and agenda​