Attention: Prescribers Six Tips for Pharmacy PA Fax Requests

Following are six tips for Pharmacy Prior Approval (PA) requests submitted via fax.

• Use the correct prior approval fax form.  New forms were made available on Monday, August 28th, 2017, for both long-acting and short-acting opioids on the Drug Request Forms page of the NCTracks provider portal. The old Narcotic Analgesics form is no longer accepted.
• Answer ALL the required prior approval questions.  Not answering a question on the fax form may cause the request to be denied.
• Be sure to include the date of birth and recipient ID of the patient on the PA request.  We cannot process PA requests with a first and last name only.
• Please include both the quantity per 30 days and the length of therapy on your prior approval request.  Length of therapy can be requested for up to 6 months for short-acting opioids, and up to 1 year for long-acting opioids, regardless of how the prescriptions are written.
• Prior approval requests submitted for a brand name medication may not work for the generic equivalent, and vice versa.  Please visit https://dma.ncdhhs.gov/preferred-drug-list for access to the Preferred Drug List.
• Patients taking more than 90 mg of morphine equivalency/morphine milliequivalents (MMEs) per day must have a high dose PA.  To request a high dose Opioid PA, question #3 must be marked as “no” (which indicates the beneficiary is exceeding 120mg of morphine equivalents per day) and subsequent questions answered with beneficiary’s diagnosis and estimated length of time the beneficiary will be exceeding the dose limit.

For more information, refer to the Pharmacy Services page of the NCTracks provider portal.