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Opioid Notice for Members


Beginning January 1, 2019, there is an important change that may affect you.          

In order to improve the safety of prescription medications and prevent prescription drug abuse, we are required to follow certain rules, known as opioid safety edits and provide a Drug Management Program for some types of medications.

When will safety rules apply to you?

  • When you go to fill an existing opioid prescription, you will only be able to get a 7-day supply of medication. If your prescription is for more than 7 days, you will need to work with your doctor to get a new written prescription, which follows New York State requirements (explained below).
  • If you reach a certain pain medication dose, some prescriptions may be stopped by our system, if it’s determined that the amount of medication being filled may be unsafe for you. In some cases, the pharmacist may be able to provide you with the medication upon speaking with your doctor. In other cases, you or your prescriber will need to request a prior authorization by calling the following number at 1-888-672-7205. We have a specific coverage request form to assist you and your doctor with this process. The form may be found on the following page of our website
  • If VNSNY CHOICE decides you are at risk for misusing or abusing your opioid or benzodiazepine (i.e., Valium or Xanax) medications, we may limit how you can get these medications. This is known as a “Drug Management Program” with limitations that may:
    • Require you to get all your prescriptions for opioid or benzodiazepine medications from one pharmacy of your choice,
    • Require you to get all your prescriptions for opioid or benzodiazepine medications from one doctor of your choice,
    • Limit the amount of opioid or benzodiazepine medications we will cover for you.

How will we tell you if these limitations apply to you?

If VNSNY CHOICE and your doctor decide that one or more of these limitations should apply to you, we will send you a letter in advance with this information. A response may be required from you and it’s an important part of helping us make sure that this Drug Management Program meets your needs.

For additional information, please review the CMS Medicare Part D Opioid Policies

If you have any questions, please contact us at the number below. We’re here to help.

Call 1-866-783-1444 (TTY: 711)
7 days a week, 8 am – 8 pm

For Prior Authorization: 
24 hours a day, 7 days a week (TTY: 711)
Fax: 1-858-790-7100