Blue Cross and Blue Shield of New Mexico

December 2016


It has been shown that people who use opiates at daily doses greater than 100 to 120 morphine equivalents have a substantially higher risk of accidental overdose when compared with patients receiving less than a 100 to 120 morphine equivalents per day.1-5 Therefore, as of Jan. 1, 2017, BCBSNM Centennial Care members will be subject to a Morphine Equivalent Dose (MED) quantity limit of 120 mg per day over a rolling 90-day period.  Patients who require quantities of opiates at doses exceeding 120 MED per day, over a 90-day period, will need to obtain prior authorization. 

The MED uses a standard conversion table to translate the dose and route of each opioid a patient has received over a 24-hour period to a morphine equivalent.  For patients taking more than one opioid, the MED of different opioids must be added together to determine a cumulative dose.  An MED calculator can be found online at:

The CDC recommends nonpharmacologic and nonopioid therapy as the preferred treatment for chronic pain. In terms of pain relief and function, clinicians should weigh the benefits versus the risk when using opioid therapy.6  

Prior authorizations can be submitted via

  1. Braden JB, Russo J, Fan MY, et al. Emergency department visits among recipients of chronic opioid therapy. Arch Intern Med. 2010;170(16):1425-1432.
  2. Dunn KM, Saunders KW, Rutter CM, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85-92.
  3. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315-1321.
  4. Gomes T, Mamdani MM, Dhalla IA et al. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171:686-691.
  5. Paulozzi LJ, Kilbourne EM, Shah NG, et al. A history of being prescribed controlled substances and risk of drug overdose death. Pain Med. 2012;13(1):87-95.
  6. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016.  MMWR Recomm Rep 2016; 65:1-49. DOI:

Blue Review • December 2016

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.

P.O.Box 27630, Albuquerque, NM 87125-7630