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Elizabeth M. Whitehorn, Director

Provider Notice issued 01/16/2024

 

To: Enrolled Physicians; Physician Assistants; and Advanced Practice Registered Nurses
​Date: ​January 16, 2024
​Re: Buprenorphine for Pregnant Individuals with a Substance Use Disorder Diagnosis

The Department of Healthcare and Family Services (HFS) is providing this update regarding buprenorphine dosing for pregnant individuals with a substance use disorder (SUD) diagnosis, who, due to growing fetus and maternal weight gain, are likely to require a higher dosage than the usual 24 mg maximum dose.

HFS is working on programming to allow a total daily dose of up to 32 mg of all buprenorphine products (monotherapy as well as combination products with naloxone) for pregnant individuals with SUD without a prior authorization, when both diagnoses (pregnancy and SUD) are noted on the prescription. 

These services will be covered under both the fee-for-service (FFS) program and managed care organizations (MCOs) with a target implementation date of February 1, 2024.

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate MCO plan.

 

Kelly Cunningham, Administrator
Division of Medical Programs