Chemical dependency/substance abuse is the chronic abuse of alcohol or other drugs characterized by impaired functioning, debilitating physical condition, the inability to reduce or cease consumption of the substance, or the need for daily use of the chemical in order to function. The term “chemical” includes alcohol and addictive drugs, but does not include caffeine or tobacco.
Medication assisted treatment is the use of medications, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of chemical dependency. Research shows that when treating chemical dependency, a combination of medication and behavioral therapies is most successful. Medication assisted treatment is clinically driven with a focus on individualized patient care.
BlueCross BlueShield of Tennessee supports the use of medication assisted treatment for chemical dependency. To help ensure that members receive the most appropriate level of care for this condition BlueCross BlueShield of Tennessee requires the following level of treatment oversight:
Pharmacy Management will conduct an ongoing review of the member’s program treatment medication(s) and all other pharmaceutical agents/drugs used by the member
The member will be assisted and followed closely by a Behavioral Care Manager who will:
Establish a treatment plan
Confirm that the member is receiving adequate psychotherapy and counseling
Confirm that the member is participating in group support with an appropriate level group (i.e., Alcoholics Anonymous and/or Narcotics Anonymous)
Contact the provider as deemed appropriate
Confirm that the member is in compliance with the treatment program (Note: Non-compliance will be reported to Pharmacy Management and this may result in termination of the prior authorization needed to obtain the program treatment medication(s) under the member’s pharmacy benefit.)
ORIGINAL EFFECTIVE DATE: 5/4/2011
MOST RECENT REVIEW DATE: 5/4/2011
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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