Carriers' Alternatives to Treat Pain

DOI Bulletin 2019-06 - Guidelines for Pain Management Alternatives to Opioid Products Updated June 2025

Carrier Name	Alt Med #1 NSAIDs	Strength/ Dosage  Limits	Alt Med #2 Topical Analgesics	Strength/ Dosage  Limits	Alt Med #3 Cox-2 Inhibitors	Strength/ Dosage  Limits	Alt Med #4 Skeletal Muscle Relaxants	Strength/ Dosage  Limits	Alt Med #5 Anti-Depressants	Strength/ Dosage  Limits	Alt Med #6 Anti-Convulsants	Strength/ Dosage  Limits	Alt Med #7 Cortico-Steroids	Strength/ Dosage  Limits	Alt Med #8 Other Alternatives	Strength/ Dosage  Limits
Aetna Health Inc. and  Aetna Life Insurance Company	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	None	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	None	Yes	Varies by medicine
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	60 capsules per 30 days.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.
Blue Cross and Blue Shield of Massachusetts, Inc.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	60 capsules per 30 days.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.
Boston Medical Center Health Plan, Inc.	Yes	Ibuprofen, Meloxicam, Naproxen	Yes	Lidocaine 5% patch: 3 patches/day	Yes	Celecoxib: 2 capsules/day	Yes	Cyclobenzaprine, Baclofen	Yes	Venlafaxine tab, Desvenlafaxine ER, Duloxetine	Yes	Pregabalin capsule: varies by strength	Yes	Prednisone	Yes	Varies by medication
Cigna Health and Life Insurance Company	Yes	Per FDA label	Yes	Per FDA Label	Yes	Per FDA Label	Yes	Per FDA Label	Yes	Per FDA Label	Yes	Per FDA Label	Yes	Per FDA Label
Fallon Community Health Plan, Inc. and Fallon Health and Life Assurance Company	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	None	Yes	None	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.
Harvard Pilgrim Health Care, Inc.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medication.	Combination products (ex: BUTAL/APAP) - Yes	Varies by medication
Health New England, Inc.	Yes	Some meds may have QL	Yes	Some meds may have QL	Yes	QL	Yes	Some meds may have QL	Yes	Some meds may have QL	Yes	Some meds may have QL	Yes	Some meds may have QL	Yes	Some meds may have QL
Mass General Brigham Health Plan, Inc.	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug	Yes	Varies by drug
Tufts Health Public Plans, Inc.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medicine.	Yes	Varies by medication.	Combination products (ex: BUTAL/APAP) - Yes	Varies by medication
UnitedHealthcare Insurance Company	Yes	Sprix 15.75mg (ketorolac tromethamine) nasal spray - 5 bottles per prescription	Yes	Lidocaine 5% ointment - 1.19 grams per day ZTLIDO - 3 patches per day Lidocaine 5% patch - 3 patches per day	Yes	No limits	Yes	No limits	Yes	Drizalma 20mg, 30mg, 60mg - 2 capsules per day Drizalma 40mg - 1 capsule per day Pristiq 25mg, 50mg, 100mg - 1 tablet per day Savella 12.5mg, 25mg, 50mg, 100mg - 2 tablets per day Savella Titration Pack - 1 pack per 365 days	Yes	No limits	Yes	No limits

Alt. Non Med	Acupuncture		Chiropractic		Physical Therapy		Occupational Therapy		Physician Medicine/Rehabilitation		Cognitive Behavioral Therapy		Nutrition Counseling		Osteopathic Manip Medicine		Nerve Block		Spine Surgery		TENS Unit
Carrier Name	Covered?	Benefit Limit	Covered?	Benefit Limit	Alt Non Med #3	Benefit Limit	Alt Non Med #4	Benefit Limit	Alt Non Med #5	Benefit Limit	Alt Non Med #6	Benefit Limit	Alt Non Med #7	Benefit Limit	Alt Non Med #8	Benefit Limit	Alt Non Med #9	Benefit Limit	Alt Non Med #10	Benefit Limit	Alt Non Med #11	Benefit Limit
Aetna Health Inc. and  Aetna Life Insurance Company	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.
Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.	Yes	12 per year.	Yes	No limits.	Yes	Merged Market: Habilitation services: 60 per year, combined with occupational therapy; Rehabilitation Services: 60 per year, combined with occupational therapy;  Large Group: 60 per year, combined with occupational therapy	Yes	Merged Market: Habilitation services: 60 per year, combined with physical therapy; Rehabilitation Services: 60 per year, combined with physical therapy;  Large Group: 60 per year, combined with physical therapy	Yes	No limits; subject to medical necessity.	Yes	No limits; subject to medical necessity	Yes	No limit on covered visits if medically necessary	Yes	No limit on covered visits if medically necessary	Yes	No limit on covered visits if medically necessary	Yes	Subject to medical necessity.	Yes	Covered under the Durable Medical Equipment benefit when medically necessary
Blue Cross and Blue Shield of Massachusetts, Inc.	Yes	12 per year.	Yes	No limits.	Yes	60 per year, combined with occupational therapy	Yes	60 per year, combined with physical therapy	Yes	No limits; subject to medical necessity.	yes	No limits; subject to medical necessity	Yes	No limit on covered visits if medically necessary	Yes	No limit on covered visits if medically necessary	Yes	No limit on covered visits if medically necessary	Yes	Subject to medical necessity.	Yes	Covered under the Durable Medical Equipment benefit when medically necessary
Boston Medical Center Health Plan, Inc.	Not covered	N/A	Yes	No limits.	Yes	60 combined occupational and physical therapies visit limit per year; prior authorization after 12 visits.   No benefit limit when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health care or early intervention services.	Yes	60 combined occupational and physical therapies visit limit per year; prior authorization after 12 visits.   No benefit limit when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health care or early intervention services.	Yes	60 combined occupational and physical therapies visit limit per year; prior authorization after 12 visits.   No benefit limit when any of these covered services are furnished to treat autism spectrum disorders or as part of covered home health care or early intervention services.	Yes (through Carelon)	No limits.	Yes	No limits; prior authorization required.	Yes	No limit; services based on medical necessity.	Yes	No limit; services based on medical necessity.	Yes	No limits; services based on  medical necessity.	Yes (through Northwood)	Services based on medical necessity; prior authorization required.
Cigna Health and Life Insurance Company	Yes, if elected by the plan.	Benefit Limits are plan  dependent.	Yes, if elected by the plan.	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.	No	N/A	Yes	No authorization is needed for evaluation and management	Yes	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.	Yes	Benefit Limits are plan  dependent.
Fallon Community Health Plan, Inc.	Not Covered	N/A	Yes	N/A	Yes	Physical and occupational therapy services are covered for up to 60 visits combined per benefit period when medically necessary with a PCP referral. After 60 combined physical and occupational therapy visits per year, prior authorization based on medical necessity is required for additional visits.	Yes	Physical and occupational therapy services are covered for up to 60 visits combined per benefit period when medically necessary with a PCP referral. After 60 combined physical and occupational therapy visits per year, prior authorization based on medical necessity is required for additional visits.	Yes	Physiatry services are covered as part of admission to an acute inpatient rehabiliation facility, which requires prior authorization.	Yes	N/A	Yes	N/A	Yes	N/A	Yes	First two (2) nerve blocks in a 12-month period do not require prior authorization. Any subsequent nerve blocks during the 12-month period will require prior authorization.	Yes	Prior authorization required.	Yes	Coverage of TENS for acute post-operative pain is limited to 30 days (one month's rental) from the day of surgery. When used for the treatment of chronic, intractable pain other than chronic low back pain, the TENS unit must be used by the plan member on a trial basis for a minimum of one month (30 days), but not to exceed two months, to determine efficacy. For coverage of a purchase, the treating practitioner must determine that the plan member is likely to derive significant therapeutic benefit from continuous use of the unit over a long period of time.
Harvard Pilgrim Health Care, Inc.	Yes	Varies by plan.	Yes	IndSmGrp - no limits LgGrp Varies by plan: 10 to 100 or unlimited visits..	Yes	Varies by plan: 10 to 100  or unlimited visits.	Yes	Varies by plan: 10 to 100  or unlimited visits.	Yes	Varies by plan. Prior authorization may be required.	Yes	Outpatient mental health - individual/group therapy is unlimited.	Yes	No limits, but  must be medically necessary.	Yes	Varies by plan.	Yes	No benefit limit; services based on medical necessity.	Yes	No limits;  if medical necessity.	Yes	under DME benefit - no limit, based on medical necessity
Health New England, Inc.	Yes	12 visits	Yes	IndSmGrp - no limits; LgGrp - 12 per year	Yes	60 per year;  combined with occupational therapy	Yes	60 per year; combined with physical therapy	Yes	60 per year combined	Yes	No limits.	Yes	4 per year as preventive	Yes	No limits.	Yes	No limits.	Yes	No limits.	Yes	No benefit limit; services based on medical necessity.
Mass General Brigham Health Plan, Inc.	Yes	Varies by plan	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan..	Yes	Varies by plan.	Yes	Varies by plan.	Yes	Varies by plan and medical necessity.	Yes	Varies by plan and medical necessity.	Yes	Varies by plan and medical necessity.
Tufts Health Public Plans, Inc.	No	N/A	Yes	No Limits	Yes	PA required after initial evaluation and 11 visits; covers up to 60 combined visits of Physical and Occupational Therapties per Member per Plan Year.	Yes	PA required after initial evaluation and 11 visits; covers up to 60 combined visits of Physical and Occupational Therapties per Member per Plan Year.	Yes	As noted in other columns, PT and OT limits apply	Yes	No Limits; however, Intermediate and Inpatient services require provider notification.	Yes	Initital nutritional status assessment required	Yes	No Limits	Yes	No Limits	Yes	No Limits	Yes	No Limits; plan does not cover cost of Neuromuscular stimulators or related Supplies.
UnitedHealthcare Insurance Company	SG - not covered; LG - optional (buy-up)	LG - no prior auth, optional benefit limits: [Limited to [10 - 100] treatments per year.] [Limited to [10 - 100] treatments per year, not to exceed $[100 - 5,000] per year.] [Limited to $[100 - 5,000] per year.]	Yes	SG - no prior auth, unlimited visits;                  LG - optional prior auth, optional [10 - 100] visits	Yes	SG - no prior auth, 44 visits;                                 LG - optional prior auth, optional [10 - 100] visits	Yes	SG - no prior auth, 44 visits;                                                          LG - optional prior auth, optional [10 - 100] visits	Yes		Yes	SG - no prior auth, 20 visits;                                                          LG - optional prior auth, optional [10 - 100] visits	Yes		Yes	SG - no prior auth, 44 visits;                                 LG - optional prior auth, optional [10 - 100] visits	Covered if clinical requirements are met.		SG - not covered;                               LG - optional (buy-up)	LG - prior auth optional	Covered if clinical requirements are met.