Effective March 1, 2005

In order to ensure appropriate utilization of sedative/hypnotic therapy, the department recently made system changes to require prior approval for all sedative/hypnotics. The department has decided to make a change in this policy.

Effective March 1, 2005, the preferred sedative/hypnotics will be removed from prior approval. There will be a limit of eight (8) pills per month for the preferred products. The department will have edits in place to ensure that no more than eight (8) pills per month are dispensed for each beneficiary. In order to submit a claim for eight (8) pills, pharmacies MUST enter a 30-day supply. If a days supply of less than 30 days is billed, the claim will reject for "Exceeds Daily Maximum Dose." This policy will allow the department to achieve its goal of ensuring appropriate utilization, while eliminating the need for providers to request prior approval for the preferred products.

Non-preferred sedative/hypnotic products will continue to require prior approval. If prior approval is granted for a non-preferred sedative/hypnotic, that prior approval will allow the beneficiary to obtain a maximum of eight (8) pills per month.

The department understands that there may be an occasional medical need for a dosage that exceeds eight (8) pills per month. Complete, succinct, and sound medical justification must be submitted by the physician to justify a larger 30-day supply.