January 4, 2018

Beginning Jan. 9, 2018, Texas HHS will limit the daily morphine equivalent dose (MED) that people enrolled in Medicaid fee-for-service (FFS) may receive. The initial limit will be set at 300 MED, and will be applied to all opioid prescriptions with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. The maximum allowable MED will decrease over time according to the following tentative schedule:

Tentative Date MED Limit
Jan. 2018 300
May 2018 240
Sept. 2018 160
Jan.2019 90

The gradual decline of the maximum allowable MED limit to 90 MEDs is intended to provide prescribing providers time to taper a person’s opioid prescriptions to lower doses, as recommended by the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain1.  Please review the MED criteria document (PDF).  Claims that exceed 300 MEDs will be rejected during pharmacy claims processing. Prescribing providers that request an override for claims exceeding the maximum allowable MED limit must contact the Texas Prior Authorization Call Center at 1-877-PA-TEXAS.  Managed care organizations (MCOs) are not required to follow the FFS MED limitations. Prescribing providers should contact the specific MCO, using the Prescriber Assistance Chart (PDF), for information regarding potential MED limitations.

Reference:

  1. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI: dx.doi.org/10.15585/mmwr.rr6501e1.