July 6, 2020

On May 26, HHSC implemented changes to the monthly three prescription limit for Medicaid fee-for-service. Pharmacy claims for opioid medication prescribed for the initial treatment of acute pain will not count against the monthly three-prescription limit. The day supply submitted on the claim cannot exceed a 10-day supply, and the person must not have a paid claim for an opioid prescription dispensed within the last 60 days.

This information will be included in the next publication of the Pharmacy Provider Procedure Manual in July 2020. Pharmacies needing assistance with claims should contact the Pharmacy Benefits Access Help Desk at 1-800-435-4165.