News
New Opioid Prescribing Limits for Ambetter Members
Date: 09/17/18
New Opioid Prescribing Limits for Ambetter Members
Superior is committed to combating the opioid epidemic while improving the health and quality of service to our members. Effective September 17, 2018, Superior will institute Ambetter Opioid Prescribing Limits to help providers avoid opioid overutilization.
Opioid Prescribing Limitations include:
- Maximum of a 7-day supply at one time
- Maximum of 2, 7-day supply fills in any 28-day period
- Maximum of 28-day supply fills in any 90-day period
Ambetter members who have legitimate medical need for long-term opioid use may be able to continue to obtain opioid prescriptions with a prior authorization. Concessions may be considered for members who are currently taking opioids and have a claims history to support the following:
- Palliative care
- End-of-life/hospice care
- Active cancer treatment
If authorization is needed to increase a member’s maximum daily limit, please fax or call a request into the Envolve Pharmacy Solutions Prior Authorization department:
- By Fax - Submit a Prior Authorization Request Form for Non-Specialty Drugs to 1-866-399-0929.
- Forms can be found at Ambetter from Superior HealthPlan's Pharmacy webpage.
- By Phone - Call 1-866-399-0928.
For more information, please reference the following documents:
- Superior’s Ambetter Opioid Prescribing Limits Flyer (PDF)
- Superior’s Ambetter Opioid Prescribing Limits FAQ (PDF)
For any additional questions, please reach out to Superior’s Pharmacy department at 1-800-218-7453, ext. 22080.