​Prior Authorization Information

Maryland Medicaid will require prior authorization for long-acting opioids, fentanyl products, methadone for pain, and any opioid prescription that result in a patient exceeding 90 morphine milligram equivalents per day, with a standard 30-day quantity limit for all opioids set at or below 90 milligram equivalents per day.

Providers must obtain a prior authorization every six months to prescribe long-acting opioids, fentanyl products, methadone for pain and opioids above 90 milligram equivalents per day.
Prior authorization will, at a minimum, require the following items:
  • Attestation of a patient-provider agreement;
  • A medical justification for high-dose and/or long-acting opioid prescription;
  • Attestation of screen patient with random drug screen(s) before and during treatment; and
  • Attestation that a naloxone prescription was given or offered to the patient/patient's household member.
 
Patients with sickle cell anemia or patients in Hospice are excluded from the prior authorization process, but should also be kept on the lowest effective dose of opioids for the shortest required duration to minimize risk of harm.
 
HealthChoice managed care organizations may choose to implement additional requirements or limitations beyond the State's policy:

 

For questions or issues with the preauthorization process, consult our Maryland Medicaid Contacts for Pharmacy Issues.