SD Medicaid announces change to opioid prescription benefit

South Dakota Medicaid (Medicaid) recently announced changes to the prescription drug benefit regarding coverage of opioid prescriptions. In conjunction with the South Dakota Medicaid Pharmacy and Therapeutics (P&T) Committee, Medicaid stated these changes are being made to align with best practices in opioid management and to reduce the risk of opioid addiction and misuse. Change areas include:

  • Early refill threshold for controlled substances;
  • Prior authorization for one long acting and one short acting opioid product;
  • Opioid naïve patient limits;
  • Morphine equivalent dose (MED) maximum prior authorization; and
  • Additional coverage for medication-assisted treatment (MAT).

The implementation schedule for the changes is staggered to allow providers to proactively implement these requirements and to allow South Dakota Medicaid providers to begin discussions with patients to minimize potential impact.

If opioid misuse is suspected, Medicaid encouraged providers to use the many resources available, including:  Division of Behavioral Health, Centers for Disease Control and Prevention, South Dakota State Medical Association, and South Dakota Prescription Drug Monitoring (PDMP).