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Q: Since naloxone laws vary by state, what resources can I explore to better understand the naloxone legal intricacies my pharmacy team should be aware of?
A: There are subtle differences in laws surrounding naloxone prescribing and dispensing from state to state. You can learn more about naloxone state laws, standing orders, labeling/dispensing by following the links listed below for states participating in the BCBS Northern Plains Alliance program.
Q: How often will I see the safe opioid use task for patients in my pharmacy? I am thinking those who have chronic prescriptions - will they have a task each month?
A: The safe opioid use tasks are generated for new opioid prescriptions with a historical look back period of 6 months.
For example, if a patient receives the same chronic opioid prescription each month, your pharmacy team would not see a new task each month since multiple prescriptions for that same opioid medication would appear in the 6-month look back period.
In the instance that a chronic opioid patient has a change in therapy, if upon looking back at prescription claims history in the previous 6 months there is no history for the newly prescribed opioid, a Safe Opioid Use task will fire. An example would be a switch from single therapy oxycodone 20 mg extended-release to morphine 30 mg extended-release from one month to the next. The patient would get a new Safe Opioid Use task upon starting the new morphine prescription.
Q: Discussing the use of naloxone can be taboo for patients who haven't had that conversation with their pharmacist. How do you set up the discussion to create a safe place for patients?
A: Counseling on the use of opioid medications always has the potential to be a sensitive topic. It is important to emphasize that you ask that same questions for every patient starting on a new opioid medication. Explaining that these medications are incredibly effective for pain control, but they can have serious, sometimes fatal side effects often shifts the conversation to a place where patients understand you are committed to their health and safety, rather than accusing them of inappropriately using their medications.
In the case that you have gotten to the point of no return and feel like you have lost the patient, the ONE Rx teams has had success with broadly asking how the opioid has been working for the patient. For example, "I understand that you had surgery only a couple of days ago. You must be in a lot of pain. Has the medication been effective in controlling your pain?" Again, this tends to shift the conversation back to the caring, trusting environment where patients know you are looking out for their best interest.
Q: If through performing a “Safe Opioid Use Task”, I find that a patent may need resources for opioid addiction and treatment, where can I go to learn more?
A: There are dozens of resources publicly available for individuals, friends, and families struggling with addiction.
FindTreatment.gov assists in learning different treatment options as well as finding state-licensed treatment centers near you.
Substance Abuse and Mental Health Services Administration (SAMHSA) is funded through the U.S. Department of Health & Human Services. In addition to supplemental resources on treatment options, there are links to the National Helpline and National Suicide Prevention hotlines.
Q: The copay cost can sometimes be a prohibitive factor for patients seeking naloxone. Do you know what naloxone copayments are for the Medicare Blue Rx plan?
A: The price will vary depending on whether the patient has the Standard or Premier MedicareBlue Rx plan and whether the prescription is filled at a preferred pharmacy. The price will be between $0 and $46 depending on those factors. You can find a more precise answer by checking out the 2020 Medicare Blue Rx Formulary and referring to the table below.
You may also check with your local and state health department - often times they will have grants enabling you to acquire free naloxone for patients who can’t afford their co-pay. Typically this requires some additional documentation, paperwork, and separate drug storage.