Confronting the opioid epidemic

Opioid abuse is a major public health crisis in America and is only growing in our state.

In New Jersey 2,056 people died from a drug overdose in 2016, an increase of 42 percent from 2015.¹ Nationally, more than 42,000 people died from an opioid overdose in 2016 — the highest total of any year on record. About 40 percent of those deaths involved a prescription opioid.

Working with our members, providers and pharmacists AmeriHealth New Jersey has taken several steps to help confront the opioid epidemic.

Removing barriers for members

  • AmeriHealth New Jersey has removed member cost-share, after deductible is met, for injectable and nasal spray formulations of naloxone and Narcan, which is a brand of naloxone. Naloxone blocks the effects of opioids and reverses an overdose when administered in time. Read more information.
  • We cover comprehensive treatment services for members dealing with an opioid abuse disorder. For instance:
    • We offer access to a full range of inpatient and outpatient treatment options, including inpatient hospital units, outpatient units and residential facilities.
    • We do not put limits on visits to detoxification facilities.
    • We cover methadone treatment with in-network providers.
  • Because medication-assisted treatments (MATs) have proven to be effective in managing opioid dependence, there are no prior authorization requirements needed to start therapy for Vivitrol and Suboxone, two of the most common MATs.
    • Please note: All drugs obtained through AmeriHealth New Jersey’s Direct Ship Drug Program do require prior authorization.
  • Our opioid policy can be viewed here.

Supporting providers

We work closely with our network providers to give them the tools, information and resources they need to care for their patients who are prescribed opioids, including:

  • A comprehensive portfolio of online opioid awareness tools and resources.
  • Ongoing communications and education regarding the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids.

Working with pharmacists

Opioid addiction often starts from the abuse of a prescription medication. To help prevent the potential abuse and misuse of opioid medications, AmeriHealth New Jersey has policies in place to manage and monitor members' opioid prescription usage, including:

  • Five-day supply limits, which are a cumulative-day supply limit of five days per 30 days for low-dose opioids. A prescription for more than a five-day supply requires prior authorization if the prescribed amount exceeds the original 30-day timeframe.
  • Prior authorization is required for all high-dose opioids, short-acting opioids prescribed for long-term use and opioid-containing patches.
  • Pharmacy system alerts when a member fills a benzodiazepine and opioid medication within 30 days of each other.
  • Pharmacy system alerts when a member attempts to fill more than a 30-day supply of a long-acting opioid within 30 days — pharmacists receive a similar message for short-acting opioid medications.

¹Centers for Disease Control and Prevention