TO: ALL Providers
Effective
November 26, 2018, Alabama Medicaid will increase the refill tolerance
threshold for both agonist and partial agonist opioids from 75% to 85% of the
original days’ supply. This applies to all outpatient pharmacy claims for
opioids.
The refill
tolerance thresholds for all other drugs will remain the same: for quantities
equal to or less than a 34-day supply, the refill tolerance threshold will
remain at 75% of the original day’s supply. For quantities greater than a
34-day supply, the designated amount is 90% of the original days’ supply.
Policy questions
related to this provider notice should be directed to the Pharmacy Clinical
Services Program at 334-242-5050.
The
Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes
descriptors, and other data are copyright © 2018
American Medical Association
and © 2018 American Dental Association (or such other date
publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply