The Revised CDC Chronic Pain Guidelines and Payer Opioid Analgesic Policies in Michigan

Abstract The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to allow increased flexibility. Opioid prescribing policies during 2019-2023 for seven large commercial payers and Medicaid fee-for-service in Michigan were reviewed. Six payers did not change the 50-90 morphine milligram equivalents (MME) daily opioid dosage limit from the 2016 guidelines. However, the six payers implemented prior authorizations and step-edits to allow some flexibility. Two payers cautioned against abrupt discontinuation or rapid tapering of opioids. In 2019 five payers exempted patients with sickle cell pain from the limitations compared to seven payers in 2023. The Michigan commercial and public payers reviewed showed some flexibility in their prescribing policies but through implementing time- and resource-consuming processes to exceed the daily opioid limits and duration of therapy. Most payers, but not all, exempted the diagnosis of sickle cell disease pain from the limits. The impact of slow payer uptake of the 2022 guidelines on opioid prescribing is unknown.