ALERT: Medicaid To Require Prior Approval for Some Opioid Dosing Beginning Aug. 27

Be aware that beginning Aug. 27, NCTracks will require prior approval for opioid analgesic doses exceeding 120 mg of morphine equivalents per day, for greater than a 14-day supply of any opioid and for any non-preferred opioid product for Medicaid and Health Choice beneficiaries.

The prescribing provider may submit prior authorization requests through NCTracks via fax or the NCTracks secure provider portal. Beneficiaries with diagnosis of terminal cancer will continue to be exempt. New opioid analgesic prior authorization forms and revised clinical coverage criteria will be available on the NCTracks website. This change also includes a new feature for prescribers to view only lock-in drugs or opioid analgesics when performing medication history searches for beneficiaries. However, the data represents only opioid claims paid by NC Medicaid and should not be used as a replacement for reviewing the NC Controlled Substance Reporting System (CSRS) as required by clinical coverage criteria and the recently passed Strengthen Opioid Misuse Prevention (STOP) Act, S.L. 2017-74.

To learn more about the background of this new requirement and the state’s Opioid Action Plan, announced in June by Gov. Roy Cooper and NC Department of Health and Human Services Secretary Mandy Cohen, read the article in the July 2017 issue of the North Carolina Medicaid Pharmacy Newsletter.

 
 

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