Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 03/14/05

To: Participating Medical Assistance Pharmacy Providers

Date: March 14, 2005

Re: Maximum Quantity Limits for Fentanyl Patches

 

During routine utilization review, the department discovered inappropriate utilization of fentanyl (Duragesic) patches. Effective March 23, 2005, system edits will be in place to control inappropriate utilization.

 

All fentanyl patches will be restricted to 15 patches per month. This will allow for utilization that is consistent with product labeling.

 

The department understands that there may be an occasional medical need for a dosage that exceeds the department’s maximum quantity limits. Complete, succinct and sound medical justification must be submitted by the physician to justify a larger 30-day supply. Requests for maximum quantity or daily dose overrides must be submitted in writing and include a letter from the physician explaining the medical justification/necessity for the excess quantity. The request must include medical justification from the physician that the department should take into consideration when making its final determination. Physician’s request can be faxed to 217-524-7264 or 217-524-0404.

 

The department will continue to monitor the utilization of fentanyl patches to ensure that the edits are working properly.