Introducing Our Program Combating Opioid Misuse

Partners in Prevention and Recovery

We share your commitment to improving the health of our community, and we would like to partner with you in addressing opioid misuse and abuse and its associated adverse effects.
WellCare has created a comprehensive national Medicaid and Medicare Opioid Program for members who overuse opioid medications and/or appear to be at risk of doing so.

Program Mission

• Coordinate timely, cost-effective, integrated services to prevent the risks associated with opioid use
• Minimize inappropriate and/or excessive opioid use
• Support our members who are dependent upon and/or abusing opioids by providing care management services, education and monitoring to improve health outcomes.

The program covers a variety of services that are directed at patient safety and positive health outcomes across settings, while improving the quality of lives of the members served. These services include:

Opioid Access Controls:

• Pharmacy and PCP Lock-in for Medicaid members: Restriction to a single pharmacy and/or single PCP for Medicaid members who show an overutilization of opioid prescriptions
• Opioid Drug Management Program (Opioid DMP) for Medicare Members: Restriction to a single pharmacy and/or drug regiment for Medicare Advantage members who show an over utilization of opioid prescriptions.

Low Back Pain Program (Medicare & Medicaid): For members prescribed potentially excessive amounts of opioids for low back pain

Predictive Analytics (Medicare & Medicaid): Proactive identification of those at risk for potential opioid misuse to help facilitate early intervention- before abuse or dependence occurs.

Care Management

A key component of the program includes Care Management outreach and follow-up for members who fall into any of the aforementioned categories for our high and moderate risk populations (excluding Medicare Opioid DMP program*.)

Care managers will help members explore alternative ways of managing pain. Alternatives we offer when appropriate include:

• Referrals to alternative pain management therapies (e.g., acupuncture, physical therapy, chiropractic therapy, psychotherapy and biofeedback, yoga/stretching/tai chi, massage, heat and cold packs, etc.)
• Use of non-opioid pain medications (e.g., anti-inflammatory)
• Referrals to a pain clinic
• Referrals to detoxification resources.

For our Medicare population Opioid DMP program, significant support is received through the Pharmacy Team.

We look forward to partnering with you to combat opioid misuse in the communities we serve.

Quality care is a team effort. Thank you for playing a starring role!