New federal workers’ comp opioid policy imposes additional limitations

September 17, 2019 · Optum

A new opioid policy imposing additional fill limitations and reducing the 60-day period for required prior approval has been announced by the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP), Division of Federal Employees’ Compensation (DFEC). The new policy, outlined in FECA Bulletin 19-04, begins in the fall of 2019 and applies to federal workers’ comp claims administered by DFEC.

Fill limits
Part of this new policy addresses initial fills of opioids, which DFEC believes will better align with earlier recommendations from the Centers for Disease Control and Prevention (CDC). ). Injured workers that have been newly-prescribed an opioid will be limited to an initial seven-day supply. They may receive a total of four sequential seven-day supply prescriptions (an initial prescription and three subsequent), a total of 28 days, without prior authorization. Each sequential prescription could be for a different opioid, but no more than one opioid may be prescribed at any given time without prior approval from DFEC. The DFEC Medical Benefits Examiner may recommend authorization through the District Director Exception Process if urgent circumstances, established by “well-rationalized medical evidence,” necessitate more than one opioid at any given time during this initial 28-day period.

Prior approval
For any additional opioid prescriptions that exceed the initial 28-day period, the prescriber will be required to complete a Certification/Letter of Medical Necessity, Form CA-27 (LMN), and obtain prior approval from DFEC. Authorization periods for opioid prescriptions following the initial 28-day period will follow existing requirements and will continue to be limited to a maximum of 60 days with refills that are limited to increments of 30 days. However, DFEC encourages the treating physician to prescribe the shortest duration of opioids that will provide appropriate pain relief.

Opioid policy resource
The Optum Workers’ Comp and Auto No-fault Government Affairs team continues to track policy developments related to opioid utilization in workers’ compensation. Should you have questions on this or any other public policy developments, please contact our Government Affairs team at AskGovtAffairs@optum.com.