On August 23, 2017, the state Health Care Authority (HCA) announced a new clinical policy about opioid prescribing for Apple Health (Medicaid). This new policy will take effect on November 1, 2017. 

All Medicaid providers should have received a letter from HCA that explains the impetus for the policy, a summary of the policy, and information about online resources and webinars that will explain the policy.

The policy focusses on acute prescriptions and the transition from acute to chronic use.  The policy limits the quantity of opioids that can be prescribed to opiate naïve patients for non-cancer pain. 

The limits for new opioid prescriptions will be:

• No more than 18 doses (approximately a 3-day supply) for patients age 20 or younger.
• No more than 42 doses (approximately a 7-day supply) for patients age 21 or older.

These limits can be overridden, if medically necessary, by adding “Exempt” in the text of the prescription, similar to adding “Dispense as Written” to limit substitutions.  

To read the policy, access prescriber and pharmacist resources, or download a patient handout, please visit HCA’s website.