Opioid Prescribing Limits

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding opioid prescription limitations paid pursuant to Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective with dates of service on or after May 1, 2018, prescribers must limit the initial prescribing of opioid medications for the treatment of acute or post-operative pain to the lowest effective dose and for a quantity no more than necessary for the expected duration of pain. Providers must not exceed a five-day supply or 90 morphine milligram equivalents (MMEs) daily, except in the cases of chronic pain, cancer pain, pain related to sickle cell disease, hospice care, palliative care or medication-assisted treatment for substance use disorder. If, in a prescriber’s clinical judgement, an initial supply of more than five days or 90 MMEs is medically necessary, the prescriber must document that need in the patient’s medical record.

Failure to adhere to these requirements is a violation of SCDHHS coverage policy and shall result in the recoupment of Medicaid funds for the service during which the prescription was issued. SCDHHS intends to initiate necessary recoupments beginning with claims for dates of service on or after July 1, 2018. Copies of this notice are available at each SCDHHS Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding this proposed action is available upon request at the address cited below.

Written comments may be sent to:

Office of Health Programs

SCDHHS

Post Office Box 8206

Columbia, South Carolina 29202-8206

Comments may also be submitted by sending an email to comments@scdhhs.gov.

All comments must be received by close of business March 30, 2018.