New Opioid Analgesic Clinical Coverage Criteria Beginning August 27 2017

[Reprinted from the June 2017 Medicaid Pharmacy Newsletter]

Prior approval will be required 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.