E xpress C om m u n ication s

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Avoid telephone calls and hold times by visiting the Express Scripts Pharmacy Portal at www.express-scripts.com/corporate. The portal is home to important documents like payer sheets and the Network Provider Manual, plus offering a claims center, patient search feature and helpful instructions for processing claims. Most information available by phone can be found quickly and easily on the Pharmacy Portal, which is especially helpful during peak hours!

Express Communications

6-18-12 Page 1 of 2

Blue Cross Blue Shield of Massachusetts UPDATE Pain Management Updates Effective July 1, 2012 Program Component: Opioids with Acetaminophen

Requirements: Less than 4 g of acetaminophen/day. Prescriptions exceeding 4 g/day will reject at the pharmacy. This applies to both new and existing prescriptions. Reject code: 9G Message: Tylenol max strength 4000mg/day exceeded

More Details: This limit follows FDA safety recommendations.

Elimination of mail order for opioid prescriptions

Opioids prescriptions will only be available at retail pharmacies. This applies to both new and existing prescriptions.

This is intended to prevent opioid diversion.

Short-acting opioids (new start RXs only*)

Up to a 15-day supply for initial prescriptions without Prior Authorization Up to an additional 15-day supply can be obtained within 60 days without Prior Authorization Prior Authorization is required for subsequent prescriptions

The following key elements will be encouraged as part of the Prior Authorization process:

Reject code: 75 Message: PA REQUIRED FOR >3 DAYS TREATMENT** Long-acting opioids (new start RXs only*)

Prior Authorization is required.

Suboxone & buprenorphine

Prior Authorization is required of prescriptions for Suboxone and buprenorphine. Buprenorphine and Suboxone daily dose may not exceed 16 mg per day without prior authorization.  60 tablets of 8 mg for 30 day supply  90 tablets of 2 mg for 30 day supply Suboxone for addiction may only be prescribed by physicians that are specially qualified to prescribe Suboxone and registered with the DEA. Suboxone treatment for pain management will not be covered This applies to both new and existing prescriptions.

Reject code: 75 Message: PA REQUIRED FOR >3 DAYS TREATMENT**

Informed Consent with risk assessment for addiction Treatment Plan Pain Management Contract Recommend use of same prescriber and pharmacy, when possible

Rejection code: 75 Message: PA required

* Members with a claim history for any opioid medication (short or long-acting) within the 90 days prior to 7/1/12 will be grandfathered and therefore do not require Prior Authorization. ** Please dispense a three (3)-day supply of either short or long-acting opioids if the claim requires Prior Authorization and the prescriber is unavailable. The three (3)-day supply is available to allow the member to receive treatment for acute pain while allowing a sufficient time for prescriber to submit a Prior Authorization request. Please note the member will be responsible for U&C or copay of the 3-day supply. Confidential & Proprietary

Avoid telephone calls and hold times by visiting the Express Scripts Pharmacy Portal at www.express-scripts.com/corporate. The portal is home to important documents like payer sheets and the Network Provider Manual, plus offering a claims center, patient search feature and helpful instructions for processing claims. Most information available by phone can be found quickly and easily on the Pharmacy Portal, which is especially helpful during peak hours!

Express Communications

6-18-12 Page 2 of 2

Blue Cross Blue Shield of Massachusetts UPDATE (Cont.) Pain Management Updates Effective July 1, 2012

To request: Prior authorization

Via the Internet: Log on to www.bluecrossma.com/provider, select Resource Center>Forms>Prior Authorization and Formulary Exception Form.

Prescribers may request a Prior Authorization using the ExpressPAth online tool. Prescribers may also fax the Prescription Opioid Prior Authorization Form to Express Scripts at the number indicated on the form or call Clinical Pharmacy Operations at 1-800-366-7778. Prescribers can indicate members who have cancer or who are receiving end of life care, and are therefore exempt from this program.

Confidential & Proprietary