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HCA to implement opioid clinical policy for Uniform Medical Plan on Jan. 2


OLYMPIA – Opioid use disorder (misuse and addiction) is a national public health crisis. More than 90 Americans die every day from an opioid overdose. Studies show that patients are often prescribed more opioids than they need, and the risk of moving to chronic use rises dramatically with longer initial prescriptions.

As part of Washington State’s strategy to combat this crisis, starting Jan. 2, 2018, the Health Care Authority (HCA) will implement an opioid clinical policy for Uniform Medical Plan (UMP). HCA manages prescriptions for UMP, the state’s self-insured Public Employees Benefits Board (PEBB) Program medical plan.

HCA’s opioid clinical policy for UMP will limit the number of opioids that UMP will cover. The policy is a direct response to Governor Jay Inslee’s executive order to combat the opioid crisis. By promoting safe prescribing practice, the policy is a tool to prevent misuse and addiction. Gov. Inslee last week issued his supplemental budget proposal, which included additional funding for the state to combat opioid addiction.

The policy sets the following limits:

  • For people ages 20 or younger: 18 pills or 90 ml of liquid per prescription (about a three-day supply)
  • For people ages 21 or older: 42 pills or 210 ml of liquid per prescription (about a week’s supply)

The policy does not apply to UMP members who are:

  • Already receiving ongoing opioid therapy.
  • Receiving cancer treatment.
  • In hospice care, palliative care, or end-of-life care.

The policy aligns with the prescribing guideline from the Washington State Agency Medical Directors Group and the Centers for Disease Control and Prevention opioid guidelines.

In addition to an opioid clinical policy for UMP, HCA also implemented an opioid clinical policy for Apple Health (Medicaid). That policy took effect Nov. 1, 2017.

Learn more about HCA’s opioid clinical policy for UMP and the opioid crisis

Media contacts

Amy Blondin, Chief Communications Officer, 360-725-1915

About Washington State Health Care Authority

HCA oversees the state’s top two health care purchasers — Washington Apple Health (Medicaid) and the Public Employee Benefits Board Program. We work with partners to help ensure Washingtonians have access to better health and better care at a lower cost. For more information, visit www.hca.wa.gov.