NCTracks
How to Submit a “High Dose� Opioid Pharmacy Prior Approval
Effective August 27, 2017, prior approval is required for opioid analgesic doses that exceed 120mg of morphine or equivalent doses per day.
Please remember when entering a prior approval request for opioids, question #3 is referring to all opioid products combined that the beneficiary is receiving. If the total daily dose is equal to or greater than 120mg of morphine equivalents per day, a high dose PA is required.
Question #3: Is the requested daily dose in combination with other concurrent opioids less than or equal to 120mg of morphine or an equivalent dose?
To request a high dose PA, question #3 must be marked as “no” (which indicates the beneficiary is exceeding 120mg of morphine equivalents per day) and subsequent drop- down fields populated with beneficiary’s diagnosis and estimated length of time the beneficiary will be exceeding dose limits.
The provider can review the beneficiary’s opioid medication history in the provider portal which may provide assistance in determining the beneficiary’s total daily opioid dose. Please see the below link for assistance in utilizing this feature.