Beginning October 30th Reminder – Opioid Clinical Criteria and Prior Approval Changes

Schedule III/IV opioids are subject to the same opioid clinical coverage criteria as schedule II opioids. Schedule III/IV opioids may require a ‘high-dose’ prior approval (PA) when cumulative opioid point-of-sale pharmacy claims exceeds the state approved morphine milliequivalence (total daily doses greater than 90 morphine milliequivalents (MMEs) per day). These medications will start requiring a PA as of September 30, 2018.