The Agency has developed policies and companion documents in response to operationalizing the Governor’s Opioid Executive Order (EO).
Attached is the AHCCCS Medical Policy Manual Pharmacy Policy 310-V and Exhibits V-2 and V-3 which have been updated to address the Governor’s EO.
The attached policy changes for the EO become effective on April 1, 2017.
There are two sections of the policy, Sections F & G that were updated. Section F briefly discusses the requirement of prior authorization for long-acting opioids. Because the AHCCCS P&T approved prior authorization of all long-acting opioids beginning on January 1, 2017, the changes made in the policy for the EO, only address short-acting opioids.
Section G operationalizes the Governor Opioid Executive Order: 7-day opioid limitation for short-acting opioids for members under the age of 18 and members 18 years of age and older. The EO differentiates the requirements for these two groups which are included in the policy and both have exclusions listed under each of them.
Also, attached is Exhibit 310-V-2 which addresses the 7-day limit exclusions and what the expectations of the prescriber and pharmacy are in order to obtain the override for the exclusion.
The last attachment is Exhibit 310-V-3 which provides ICD-10 diagnosis codes and their descriptions which relate to Exhibit V-2 requirements in order to obtain an override for an exclusion. Many of the exclusions require an ICD-10 code determined by the prescriber in order for the pharmacy to contact the Contractor or the Contractor’s PBM help desk for an override.
All of these documents are also available on the AHCCCS website and can be found under the “Pharmacy” section under the “Policies” tab. They are also located in the AHCCCS Medical Policy Manual under Resources. Our website is www.azahcccs.gov
AHCCCS will also have an additional document that lists our the plans, their PBMs, telephone numbers to call during business hours and also after hours that I will forward to you when it becomes available.
AHCCCS Medical Policy Manual Pharmacy Policy 310-V
AHCCCS Medical Policy Manual Exhibit 310-V-2: 7-day limit exclusions
AHCCCS Medical Policy Manual Exhibit 310-V-3: diagnosis codes