19-707 To Help You End Opioid Abuse: Preferred Drug List Changes Focus on Opioid Pain Medications
Date: 09/11/19
Broad changes to the Preferred Drug List (PDL) are effective October 15, 2019
California Health & Wellness Plan (CHWP) is making significant changes to the Preferred Drug List (PDL).
These changes are in response to input from providers, regulatory changes, nationally recognized standard of care or treatment guideline changes, as well as the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee reviews the PDL quarterly, at a minimum, to determine placement of medications on the drug list and any limitations to coverage. The P&T Committee consists of practicing physicians, pharmacists and other health care professionals.
These changes are considered more restrictive than prior PDL changes. Changes may include differences to the quantity limits (QL), age limits (AL), step therapy (ST), prior authorization (PA) status, formulary (F), and non-formulary (NF) status.
Note changes for opioids to prevent misuse
Note significant changes to the quantity limits and prior authorization requirements for opioid pain medications. These changes follow current treatment guidelines and standards of care for the utilization and prescribing of these medications. The goal is to improve safety and prevent abuse, overdose and diversion in response to the increased awareness of the opioid epidemic.
These medications will be updated with quantity limits and dosing that corresponds in most cases to less than or equal to 90 morphine milligram equivalents (MME) daily. In addition, opioid treatment-naïve patients may be limited to a seven-day supply on the first fill of preferred opioid pain medications. Requests for greater than seven days for opioid-naïve patients and requests for dosages that exceed 90 MME daily may require prior authorization. These new changes and quantity limits will be used in collaboration with the previously approved and implemented Opioid Utilization Management Program.
For the most current information and details about specific limits and restrictions, visit the CHWP website at www.CAHealthWellness.com. Go to For Providers > Pharmacy > Preferred Drug List (PDL).
Additional information
Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305. For prior authorization, fax 1-877-259-6961.
Changes to the PDL, effective October 15, 2019
The table below lists medications and their status on the PDL.
Changes to the PDL, effective October 15, 2019 | ||
Medication | Status | Comments |
Acetaminophen with codeine tab 300-15 mg, 300-30 mg, 300-60 mg | F | QL updated |
Acetaminophen with codeine solution (soln) 120-12 mg/5 ml | F | QL updated |
Butalbital-acetaminophen-caffeine with codeine cap 50-300-40-30 mg, 50-325-40-30 mg | F | QL updated |
Butalbital-aspirin-caffeine with codeine capsule (cap) 50-325-40-30 mg | F | QL updated |
Codeine sulfate tab 15 mg, 30 mg, 60 mg | F | QL updated |
Fentanyl transdermal (TD) patch 72-hour (hr), 12.5 mcg/hr, 25 mcg/hr, 50 mcg/hr, 75 mcg/hr, 100 mcg/hr | F | QL updated |
Hydrocodone-acetaminophen tab 5-325 mg, 7.5-325 mg, 10-325 mg | F | QL updated |
Hydrocodone-acetaminophen tab 5-300 mg, 7.5-300 mg, 10-300 mg | F | QL updated |
Hydrocodone-acetaminophen soln 7.5-325 mg/15 ml | F | QL updated |
Hydromorphone HCl liquid 1 mg/ml | F | QL updated |
Hydromorphone HCl suppository 3 mg | F | QL updated |
Hydromorphone HCl tab 2 mg, 4 mg, 8 mg | F | QL updated |
Hydromorphone HCl tab extended-release (ER) 24-hr deterrent 8 mg, 12 mg, 16 mg | F | QL updated |
Meperidine HCl oral soln 50 mg/5 ml | F | QL updated |
Meperidine HCl tab 50 mg, 100 mg | F | QL updated |
Methadone soln 5 mg/5 ml | F, PA | PA, QL updated |
Methadone tab 10 mg | F, PA | PA, QL updated |
Methadone tab 5 mg | F, PA | PA, QL updated |
Morphine sulfate (concentrate) oral soln 20 mg/ml | F | QL updated |
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Changes to the PDL effective October 15, 2019, continued | ||
Medication | Status | Comments |
Morphine sulfate beads cap ER 24-hr 30 mg, 45 mg, 60 mg, 75 mg, 90 mg, 120 mg | F | QL updated |
Morphine sulfate injection (inj) 0.5 mg/ml, 1 mg/ml, 2 mg/ml, 4 mg/ml, 5 mg/ml, 8 mg/ml, 10 mg/ml, 15 mg/ml | F | QL updated |
Morphine sulfate IV soln 5 mg/ml, 25 mg/ml, 50 mg/ml | F | QL updated |
Morphine sulfate oral soln 10 mg/5 ml, 20 mg/5 ml | F | QL updated |
Morphine sulfate suppository 5 mg, 10 mg, 20 mg, 30 mg | F | QL updated |
Morphine sulfate tab 15 mg, 30 mg | F | QL updated |
Morphine sulfate tab controlled-release (CR) 15 mg, 30 mg, 60 mg, 100 mg, 200 mg | F | QL updated |
Oxycodone-aspirin tab 4.88-325 mg | F | QL updated |
Oxycodone HCl cap 5 mg | F | QL updated |
Oxycodone HCl concentrate 100 mg/5 ml (20 mg/ml) | F | QL updated |
Oxycodone HCl soln 5 mg/5 ml | F | QL updated |
Oxycodone HCl tab 5 mg, 10 mg, 20 mg, 30 mg | F | QL updated |
Oxycodone HCl tab ER 12-hr deterrent 10 mg, 20 mg, 30 mg, 40 mg, 60 mg, 80 mg | F, PA | QL updated |
Oxycodone with acetaminophen tab 5-325 mg, 7.5-325 mg, 10-325 mg | F | QL updated |
Oxycodone with acetaminophen soln 5-325 mg/5 ml | F | QL updated |
Tapentadol HCl tab sustained-release (SR) 12-hr 50 mg, 100 mg, 150 mg, 200 mg, 250 mg | F, PA | QL updated |
Tramadol HCl tab 50 mg | F | QL updated |
Tramadol-acetaminophen tab 37.5-325 mg | F | QL updated |
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