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November 1, 2005
 
MEDICAID INFORMATION RELEASE 2005-34
 
TO:                 Prescribing Providers, Pharmacists, Pharmacies, Hospitals, and Long-Term Care Facilities
 
FROM:           Randy May, Deputy Administrator
 
SUBJECT:      Replacing information in IR 2004-45: NEW PRIOR AUTHORIZATION CRITERIA FOR LONG ACTING OPIOID DRUG CLASS.
 
Drug/Drug Class:
LONG ACTING OPIOIDS
Implementation Date:
Effective for dates of service on or after December 1, 2005
 

Idaho Medicaid is designating new preferred agents and therapeutic criteria for the Long Acting Opioid drug class as part of the Enhanced Prior Authorization Program. Beginning December 1, 2005, the preferred agents for the Long Acting Opioid drug class will be the following:
 
Preferred Agent(s)
Non-preferred Agents^
Morphine Sulfate (extended release)
Methadone
Kadian®
Avinza®
Duragesic® patches
MS Contin ®
Oxycodone HCl long-acting
OxyContin®
^ Use of non-preferred agents must meet additional prior authorization requirements.
 
Therapeutic Criteria
1)      Patients with a diagnosis of malignant pain or history of chemotherapy in the past 12 months will be exempt from the prior authorization criteria.
2)      Minimum 30 day trial period and documented failure of a preferred agent is required before use of a non-preferred agent will be authorized.
3)      Duragesic® will be authorized if one or more of the following criteria are met:
§         Documented trial and failure of preferred agent as outlined above.
§         Patient is age 65 or older
§         Patient is unable to take oral medications
§         Patient is allergic to morphine or methadone
 
Questions regarding the Prior Authorization program may be referred to Medicaid Pharmacy at (208) 364-1829.

 
A current listing of all the preferred agents by drug class and prior authorization criteria is also available online at www.medicaidpharmacy.idaho.gov.
 
IDAHO MEDICAID PROVIDER HANDBOOK
This Information Release does not replace information in your Idaho Medicaid Handbook.
RM/cb