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.

You cannot enter the High Dose Indicator on the NCTracks provider portal. This indicator is set automatically.  The High Dose Indicator default value is unchecked which means ‘NO’.  The value will be updated to checked meaning ‘YES’ it is high dose if:

• The response is ‘YES’ to the question: Does the patient have a diagnosis of malignant cancer or pain due to neoplasm? OR
• The response is ‘NO” to the question: Is the requested daily dose less than or equal to 120mg of morphine or an equivalent dose?

If you answer ‘NO’ to the question “Is the requested daily dose less than or equal to 120 mg of morphine or an equivalent dose,” this answer indicates that a High Dose PA is being requested, and the following information is required:

• Please supply the beneficiary’s diagnosis and reason for exceeding dose per day limits.
• Please provide the duration (days’ supply) the beneficiary will exceed the limit of 120mg of morphine or an equivalent dose.