Module 4: Therapeutics

Lesson 1

Awareness of drug plan limits and exceptional access programs

It is important to be aware of drug plan limits, exceptional access programs, the Non-Insured Health Benefits Prescription Monitoring Program (NIHB-PMP), and the current status of non-insured health benefits (NIHB).

The NIHB-PMP has set quantity limits on a number of drugs through dose limit initiatives at the point of sale (pharmacy). These policies target overuse of drugs in order to increase client safety. New dose limits include:

• Opioids: Effective September 30, 2013, a daily opioid dose limit of 600 mg has been implemented. A more stringent dose limit of 500 mg morphine equivalents per day took effect October 20, 2014. Clients who have been identified as palliative or cancer patients are excluded from opioid dose limitations.
  • The objective of this initiative is to monitor and gradually reduce the number of program clients receiving doses of opioids above the “watchful dose” of 200 mg morphine equivalents per day. New recommendations in the updated Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain (National Opioid Use Guideline Group (NOUGG), 2017) have further reduced the dose to 90 mg of oral morphine equivalents per day. These dose limits are based on best practice and are intended to enhance patient safety, to trigger communication between users and prescribers about high doses of opioids, and to encourage prescribers to safely taper clients to an appropriate dose. In addition, all opioids listed are subject to a maximum 30-day supply when filling a prescription. Refills are not permitted.
• Gabapentin: As of February 2014, dose limit lowered to 4,000 mg/day.
• Benzodiazepines: As of September 2014, dose limit lowered to 60 mg/day. The limit will be lowered again in the future to a target dose of 40 mg/day.
• Acetaminophen: As of October 2013, a dose limit of 3600 mg/day has been placed on products containing acetaminophen as a single ingredient or in combination with an opioid.