Please read the following notice from the HCA:
In April 2019, the Health Care Authority (HCA) informed providers, pharmacies, and managed care organizations (MCOs) that more policy changes would be coming as a result of SUPPORT Act compliance. This is the first follow-up to inform you of changes effective in 2019.
Changes to opioid policy effective October 1, 2019
HCA’s current Opioid Policy will remain in effect but will be updated to include SUPPORT Act requirements.
Subsequent opioid fills:
- Currently HCA limits opioid use to a 42 day supply in a 90 day period. To receive more than 42 days in a 90 day period the provider must sign and submit an attestation form stating that they are following best practices for treating chronic pain. This meets the SUPPORT ACT safety edit criteria for subsequent fills.
Morphine Milligram Equivalent (MME) Limit
- HCA will apply a prior authorization (PA) to claims that exceed 120 MME. An attestation form that will be required to exceed 120 MME.
- For clients receiving chronic opioids the prescriber will need to submit an attestation form after 42 days of opioids in a 90 day period and an attestation form if the dose exceeds 120 MME.
Exceptions
- These policy changes only apply to prescriptions billed through the pharmacy benefit. Methadone and buprenorphine dispensed through opioid treatment programs (OTPs) are excluded from these changes.
- Buprenorphine is exempt from the MME limit.
- The current Opioid Policy allows expedited authorizations (EAs) that overrides the 42 day limit for active cancer treatment, hospice care, palliative care, other end-of-life care or if the patient is known to be a chronic opioid user at the current prescribed dose prior to Medicaid enrollment.
- These EAs will continue to override the PA required to exceed 42 days of opioids in a 90 day period.
- For claims with daily doses exceeding 120 MME, only the EA for active cancer treatment, hospice care, palliative care, or other end-of-life care will apply.
What is the SUPPORT Act?
On October 24, 2018, President Trump signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The SUPPORT Act will change aspects of Washington Apple Health (Medicaid) – specifically clinical pharmacy policy and prescription drug monitoring requirements and reporting.
Where do I learn more?
We have created a
SUPPORT Act webpage with comprehensive information which will be updated as we move forward.
I still have questions.
After reviewing the information on the
SUPPORT Act webpage, you can
email Apple Health Pharmacy Policy with additional questions.