Prior Authorization Program for Brand-Name Schedule II Narcotics

On August 4, 2008, the N.C. Medicaid pharmacy program will require prior authorization for brand-name schedule II (CII) short-acting and long-acting narcotics.  This program will replace the current Oxycontin prior authorization program. Prior authorization will not be required for patients with a diagnosis of pain secondary to cancer.

Medications that will require prior authorization include Actiq, Avinza, Demerol, Dilaudid, Duragesic, Fentora, Kadian, Levo-Dromoran, MS Contin, Opana, Oxycontin, Oramorph SR and Percocet.  Note:  This is not a complete list of the medications that will require prior authorization but represents commonly prescribed brand-name medications in these drug classes.  Generic versions of these medications will not require prior authorization. 

Prescribers can request prior authorization by contacting ACS at 866-246-8507 (fax).  Prior authorization requests for these medications will be accepted by facsimile (fax) only.  The signature of the prescriber on the request form will be required as an important safeguard against fraud and abuse. 

If a short-acting or long-acting CII narcotic medication has a generic version available, “medically necessary” must also be written on the face of the prescription in order for the brand-name drug to be dispensed.

The criteria and PA request form for these medications is available on the N.C. Medicaid Enhanced Pharmacy Program website.

Updated July 25, 2008