Provider Type(s): 20, 25, 26
Monthly Limitations–Opiate Prescriptions
Effective November 30, 2009, a maximum of four prescriptions of an opiate that is a Federal Controlled Substance, Schedules III-V (multiple drugs and multiple strengths) will be allowed per 30 days without a prior authorization. Claims over the maximum limit of four opiate prescriptions (multiple drugs & multiple strengths) per 30 days will deny for “Limit 4 duplicate prescriptions per 30 days.” The prior authorization process is available for those requests which exceed the monthly limit for opiate prescriptions.
This represents an enhancement to the programming logic that was implemented in August 2009.