Guidelines, FREE CME

You can improve the care of injured workers and help save lives by using best practices in the following guidelines:

We have specific prior authorization requirements for the payment of opioids.

Authorization & Forms

Opioid Authorization process

When is authorization needed?

  • If you are prescribing opioids 6 weeks beyond the date of injury or for post-surgery. Opioid coverage will depend on your documentation of specific best practices;
  • If you are prescribing non-preferred or long-acting opioids; or
  • If you are prescribing more than 3-day supply for dental procedures.

What do you need to do?

  • Complete the appropriate form below:
Forms Descriptions
Subacute Opioid Request Form
(F252-097-000)
Use this form to request opioid coverage between 6 weeks to 12 weeks from the date of injury or surgery.
Chronic Opioid Request Form
(F252-091-000)
Use this form to request opioid coverage beyond 12 weeks from the date of injury or surgery, or every 90 days for ongoing chronic opioid therapy.
Opioid Treatment Agreement - English
(F252-095-000)
Use this treatment agreement when starting chronic opioid therapy. It should be renewed yearly or when there is a new prescriber.
Opioid Treatment Agreement - Spanish
(F252-095-999)
Utilice este convenio de tratamiento al iniciar la terapia con opioides para controlar el dolor crónico. El convenio debe ser renovado cada año cuando hay un proveedor nuevo proporcionándole recetas.
Exception to Three-Day Limit of Opioids for Dental Procedures Request (F252-118-000) Use this form to request authorization for opioid prescriptions which exceed 3 days' supply for dental procedures.

Where should you send the form?

For State Fund Claims (claim numbers beginning with A, B, C, F, G, H, J, K, L, M, N, P, X or Y) For Self-Insured Claims (claim numbers beginning with S, T or W)
Fax completed form to the number(s) listed on the form. Contact the self-insured or their third-party administrator.

Screening & Monitoring Tools

There are many resources available to help you monitor your patients on chronic opioid therapy. The validated tools below can be used to track pain and function, screen for risk factors, calculate total morphine equivalent dose and understand urine drug testing (UDT).

What tools should you use?

Screening or tracking for: Validated tools:
Function and pain 2-Item Graded Chronic Pain Scale, 3-Item PEG Assessment Scale, QuickDash, Oswestry Disability Index or Neck Disability Index
Risk of opioid addiction ORT (Opioid Risk Tool) or The Screener and Opioid Assessment for Patients with Pain (SOAPP)® Version 1.0
Current or former substance abuse disorder CAGE-AID (Cut down, Annoyed, Guilty, Adapted to Include Drugs) or AUDIT (Alcohol Use Disorder Identification Test)
Depression PHQ-9 (Patient Health Questionnaire-9), CES-D (Center for Epidemiologic Studies Depression Scale) or GAIN-SS (Global Appraisal of Individual Needs Short Screener)
Morphine equivalent dose Opioid Dose Calculator

How often should you monitor your patient on chronic opioid therapy?

Risk category per validated tool UDT PMP Function and pain
Low risk 1/year 1/year Every 12 weeks
Moderate risk 2/year 2/year Every 12 weeks
High risk or opioid doses >120mg/d morphine equivalent 4/year 4/year Monthly (every visit)
Aberrant behavior - lost prescriptions, multiple requests for early refills, opioids from multiple providers, unauthorized dose escalation, apparent intoxication, etc. At time of visit
(address aberrant behaviors
in person, not by telephone)

Resources & Rules

Resources

Coaching and consultation

You can get coaching and advice for managing patients with complex chronic pain problems, especially involving opioids:

Example of benzodiazepine tapering protocols

If you are tapering benzodiazepines, here is The Everett Clinic’s benzodiazepine tapering algorithm and sample tapering plans:

Patient education

You can use the resources below to help your patients understand the risk and benefit of opioids, safe storage and disposal and special considerations for youth:

Continuing medical education

You can get FREE, Category 1 CME online and attendance trainings on opioid therapy and pain management:

Others

Rules