January 4, 2018

Beginning Jan. 9, 2018, Texas HHS will limit the daily morphine equivalent dose that people enrolled in traditional Medicaid may receive. The initial limit will be set at 300, and will apply to all opioid prescriptions with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. The maximum allowable limit 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. Prescribing providers and pharmacy staff should review the morphine equivalent dose criteria guide (PDF) to learn more.

Claims that exceed the 300 limit will reject during pharmacy claims processing. Prescribing providers requesting an override for claims exceeding the maximum allowable limit must contact the Texas Prior Authorization Call Center at 1-877-PA-TEXAS.

Health plans are not required to follow traditional Medicaid dosage limitations. Prescribing providers should contact the specific health, using the Prescriber Assistance Chart (PDF), for information regarding potential dosage 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.