NIHB Policy Change PLEASE NOTE: Providers are expected to MANUALLY apply the policy. Effective February 25, 2014, NIHB instituted a 30-day maximum dispense policy for ALL opioids. The policy applies to all open benefit and limited use opioids covered under the Program, as well as to other opioids that are not listed, but are covered on a case-by-case basis. One full fee will be paid per 30-day dispense (or less, if prescribed in a smaller quantity). Where opioids are prescribed to be dispensed for a longer duration as a single prescription, NIHB will only reimburse up to a maximum of 30 days at a time. For audit purposes, prescriber approval to split a prescription into 30-day dispenses will not be required for opioids. This policy also impacts the opioid dose limit calculation of 600 mg morphine equivalents per day. Previously, these dose limits were determined over a 100-day period; however, effective February 25, 2014, the calculations will occur over a 30-day period. Please be advised that due to a software issue, the claims processor is unable to automatically cut back the day supply to 30 days. Therefore: PROVIDERS ARE EXPECTED TO MANUALLY APPLY THE POLICY BEGINNING February 25, 2014 and UNTIL FURTHER NOTICE
Posted on: Thu, 06 Mar 2014 16:09:20 +0000
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