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Milestone Criteria
Current State
Future State
Summary of Actions Needed
Implementation of opioid prescribing guidelines along with other interventions to prevent opioid abuse
Wisconsin Medicaid established prescribing guidelines in alignment with Centers for Disease Control and Prevention (CDC) guidance. The Wisconsin Medical Examining Board (MEB) published Opioid Prescribing Guidelines in 2016. The MEB published updated guidelines in 2018.
Wisconsin Medicaid’s Drug Utilization Review (DUR) Board has been focused on opioid related activities. These activities include targeted intervention focused on opioid prescribing when a member’s medication use may be outside of published guidance (i.e., CDC Opioid Prescribing Guidelines). Wisconsin Medicaid has drug/drug related criteria that is used to send physicians education letters alerting them to a clinical concern and pharmacies receive a drug/drug alert informing them ofa clinical concern before the medication is dispensed.
Wisconsin Medicaid has an opioid script limit of five prescription fills a
Continue to monitor and evaluate.
No immediate action.
Wisconsin BadgerCare Reform Demonstration
Approval Period: October 29, 2024 through December 31, 2029 Page 50