The Michigan Department of Health and Human Services (MDHHS) is enforcing certain
dispensing limits on opioids to align with safe prescribing guidelines and statutory
requirements. These changes may affect the quantity of your patients’ opioid medications
dispensed at the pharmacy.
Seven-Day Supply of Opioids for Acute Pain
Pursuant to MCL 333.7333b, if a prescriber is treating a patient for acute pain, the prescriber
shall not prescribe the patient more than a 7-day supply of an opioid within a 7-day period. To
enforce this requirement, MDHHS is limiting coverage of short-acting narcotic analgesics for
Medicaid Fee-for-Service (FFS) beneficiaries who are opioid treatment-naïve to a 7-day
supply. Opioid treatment-naïve beneficiaries are identified as those who have not had a recent
Medicaid FFS claim for a narcotic drug.
If the beneficiary requires a longer duration of the opioid prescription to treat chronic pain, the
prescriber may submit a prior authorization (PA) request to override the 7-day supply limit. To
submit this request, contact MDHHS’ Pharmacy Benefits Manager (PBM) Clinical Call Center
at (877) 864-9014.
Morphine Equivalent Daily Dose (MEDD) Limits
Starting September 21, 2018, MDHHS will set a cumulative MEDD limit on pharmacy claims
for Medicaid FFS beneficiaries. This limit will prevent pharmacies from dispensing quantities
of opioids that significantly exceed prescribing guidelines issued by the Centers for Disease
Control and Prevention (CDC). The maximum allowed MEDD will continue to be lowered on a
gradual and periodic basis until MEDD thresholds align with Centers for Disease Control
(CDC) guidelines.
The prescriber may submit a PA request to override this limit by contacting the PBM Clinical
Call Center. The prescriber will need to provide clinical justification for the high MEDD
treatment plan and/or a provide a taper plan.
To avoid exceeding the MEDD limit, prescribers are encouraged to assess their patients’
opioid therapies and work with patients to develop taper plans if appropriate.
Any questions regarding this letter should be directed to
MDHHSPharmacyServices@michigan.gov. Thank you for your continued partnership to care
for Medicaid beneficiaries.
Sincerely,
Kathy Stiffler, Acting Director
Medical Services Administration