Prior Approval Begins for Opioid Doses for Medicaid and Health Choice

On Sunday (8/27/17), prior authorization will now be required for opioid analgesic doses for N.C. Medicaid and N.C. Health Choice (NCHC) beneficiaries. This new requirement covers those doses which exceed 120 mg of morphine equivalents per day, are greater than a 14-day supply of any opioid, or are non-preferred opioid products on the NC Medicaid Preferred Drug List (PDL). Prescribing physicians may submit prior authorization requests through the NCTracks portal or by fax. New opioid analgesic prior authorization forms and revised clinical coverage criteria will be available on the NCTracks website as well. Beneficiaries with diagnosis of pain secondary to cancer will continue to be exempt from prior authorization requirements. For additional information on this new requirement, visit NCTracks or download CCNC’s overview.