Date:||December 19, 2022|
|To:||Enrolled Physicians; Advanced Practice Registered Nurses; Physician Assistants; and Pharmacies |
|Re:||Initial Prescription Limit – Changes to Maximum Days’ Supply Effective February 1, 2023|
This notice informs providers that beginning February 1, 2023, the Department of Healthcare and Family Services (HFS) will update the initial prescription logic used for opioids and benzodiazepines. This impacts the fee-for-service (FFS) and HealthChoice Illinois (HCI) managed care organization (MCO) plans.
For opioids, the initial fill limit will be a maximum of five days' supply. For benzodiazepines, the initial fill limit will be a maximum of 14 days' supply. After the initial fill, prescriptions for these drugs may be filled for a 30 days' supply. The initial fill limit applies to participants who have not had another opioid or benzodiazepine claim within the past 60 days.
It should be noted that benzodiazepines have no recognized role in pain control and could be hazardous (due to risk of respiratory depression and death) if prescribed for concurrent use with opioids.
Providers can request prior authorization for chronic opioid therapy for customers with a diagnosis of chronic painful conditions, such as cancer or sickle cell disease. Upon approval, the 5-day initial fill limit will be bypassed. Continuing 30-day refills will then be available to those patients with a prescription without additional prior authorization requirements.
Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or to the applicable HCI MCO plan.
Kelly Cunningham, Administrator
Division of Medical Programs