Methadone: A Flicker Of Light In The Dark

Methadone: A Flicker Of Light In The Dark

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 IMPORTANT INFO FOR LOUISIANA MEDICAID RECIPIENTS

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lilgirllost
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PostSubject: IMPORTANT INFO FOR LOUISIANA MEDICAID RECIPIENTS    Tue Apr 26, 2011 12:22 am

State of Louisiana
Department of Health and Hospitals

Bureau of Health Services Financing

Bruce D. Greenstein


SECRETARY

Bobby Jindal
GOVERNOR



March 17, 2011

Re: Quantity Limits, Maximum Dosages, and ICD-9-CM Diagnosis Code Requirement for C-II Narcotics
Quantity Limits on Triptans, and Carisoprodol, and Maximum Dosage on Buprenorphine

Dear Prescribing Practitioner:

The Louisiana Medicaid Pharmacy Benefits Management (LMPBM) Program in collaboration with its Drug Utilization Review (DUR) Board has established maximum quantity and dosage limits for selected medications used in the management of pain. These limits will become effective on March 30, 2011. These new limits are in addition to quantity and/or dosage limits which are currently in place. Most prescriptions for recipients who have a confirmed diagnosis of cancer will be exempt from the quantity limit. To accurately determine which prescriptions should be exempt, we are requiring all prescriptions for schedule II narcotic agents to have an ICD-9-CM diagnosis code documented on the hardcopy prescription.

When the cumulative quantity for an agent is determined to be in excess of the quantity limit, the claim will deny. In order to meet the requirements for an override, the prescribing practitioner must provide the reason why the quantity limit needs to be exceededJustification for overrides must be documented on the hardcopy prescription. Compliance associated with program policy will be verified through the pharmacy compliance audit program including medical records requests.

Summary charts which address quantity limitations and maximum daily dosages are provided in the appendices of this document. Products which contain acetaminophen continue to have a maximum dosage of four (4) grams of acetaminophen daily, while products which contain aspirin continue to have a maximum dosage of six (6) grams of aspirin daily.

The Louisiana Board of Medical Examiners published rules regarding the use of medications used in the treatment of non-cancer related chronic or intractable pain. These rules are included in Title 46: Professional and Occupational Standards. Subchapter B – Medications Used in the Treatment of Non-Cancer-Related Chronic or Intractable Pain – are enclosed for your review. For more information, see
http://www.lsbme.la.gov/46v45MedicalProfessionsSeptember2009practice.htm#_Toc243144086

If you have concerns or comments regarding this correspondence, you may contact Melwyn B. Wendt at 225-342-9768 or send a fax to 225-342-1980. Your continued cooperation and support of LMPBM Drug Utilization Review (DUR) efforts are greatly appreciated.

Sincerely,
Rodney Wise, MD
Medicaid Medical Director
RW/MJT/mbw


Quantity Limits
Schedule II (C-II) Narcotic Agents Quantity limits for the Schedule II narcotic agents are listed in Table 1.
Quantity limits are cumulative and are based on a rolling thirty (30) days.
Unless otherwise specified, quantity limits apply to all strengths of an agent.
An ICD-9-CM diagnosis code indicating the reason for use must be documented on the hardcopy prescription for even for those Schedule II narcotic agents not subject to a quantity limit.

With the exception of the fentanyl buccal and sublingual products, recipients receiving the agents listed in Table 1 for the management of cancer pain are not subject to a quantity limit.

A list of cancer-related ICD-9-CM diagnosis code ranges is provided in Appendix A.


Table1. Schedule II Narcotic Agents Subject to a Quantity Limit
Description

Dosage Form

Route

Quantity Limit per
30 Rolling Days

Sample Brand Name

Fentanyl

Patch 12, 25, 50 mcg/hr

Transdermal

10 units

Duragesic®

Fentanyl

Patch 75, 100 mcg/hr

Transdermal

20 units

Duragesic®

Fentanyl Citrate Immediate Release

Tab Sublingual, Lozenge HD, Tab Effervescence, Film

Sublingual, Buccal

120 units

Abstral
®,* Actiq®,* Fentora®,* Onsolis®*

Hydromorphone HCl ER

Tab ER 24 hr

Oral

30 units

Exalgo®

Morphine Sulfate SR

CPMP 24 hr

Oral

30 units

Avinza®

Morphine Sulfate SR

Cap SR Pellet

Oral

60 units

Kadian®

Morphine Sulfate SA

Tab SA

Oral

60 units

MS Contin®

Morphine Sulfate/Naltrexone SR

Cap SR Pellet

Oral

60 units

Embeda®

Oxycodone HCl SR

Tab SR 12 hr

Oral

60 units

Oxycontin®

Oxycodone, Oxycodone/Acetaminophen, Oxycodone/Aspirin

Tab, Capsule

Oral

120 units

Magnacet
®, Percocet®, Percodan®, Roxicet®, Roxicodone®, Tylox®, Xolox®

Oxycodone/Ibuprofen

Tab

Oral

28 units

Oxymorphone HCl SR

Tab SR 12 hr

Oral

60 units

Opana ER®


ICD-9-CM Diagnosis Code Requirement

An ICD-9-CM diagnosis code must be written on the hardcopy prescription for agents listed in Table 1 and all other Schedule II narcotic agents. The diagnosis code must be written on the hardcopy prescription by the prescribing practitioner or by the pharmacist after consultation with the prescriber.

Except for methadone, when the prescribing practitioner does not indicate a diagnosis code on the prescription and when the prescriber cannot be reached, a denial for a missing diagnosis code may be overridden if the pharmacist determines that the recipient cannot wait to receive the medication.

Quantity / Daily Dosage Limits March 17, 2011 Page 2

Special Cases


Methadone:



Fentanyl: Claims for fentanyl buccal agents and sublingual agents (Abstral®, Actiq®, Fentora®, and Onsolis®) must contain a cancer-related ICD-9-CM diagnosis code in order for the claim to process for payment through the Point of Sale (POS) System. These buccal agents and sublingual agents are subject to quantity limits.
Prescriber Consultation Authorizing Quantity Limit Override
When the cumulative quantity for an agent listed in Table 1 is determined to be in excess of the quantity limit, the claim will deny. If the prescribing practitioner chooses to exceed the quantity limit, the prescribing practitioner must provide the reason why the quantity limit needs to be exceeded. The pharmacist may override the quantity limit after consultation with the prescribing practitioner. The prescriber or the pharmacist must document on the hardcopy prescription the prescriber’s reason why the quantity limit needs to be exceeded.


TO READ THE COMPLETE LETER AND LIST PLEASE CLICK ON THIS LINK
http://www.lamedicaid.com/provweb1/Pharmacy/Pres_Letter_Narc_Limit.pdf


RuthAnn
aka lilgirllost

We are not bad people trying to become good, we are sick people trying to become well.

Methadone; A Flicker Of Light In The Dark
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