Pharmacy Lock-in-program

When the need has been identified, AmeriHealth Caritas Florida assigns members to a single prescribing pharmacy to monitor, prevent and reduce the misuse of pharmacy services.

A member may be identified to enter the lock-in program if any of the following criteria are met:

• Obtained three or more controlled substance prescriptions from three or more pharmacies written by three or more different prescribers within 180 days.
• Been convicted of fraud through the unauthorized sale or transfer of a pharmaceutical product funded by Medicaid.
• Utilized more than ten different controlled substance prescribers in 90 days.
• Obtained two or more controlled substance prescriptions written by two or more different prescribers who have utilized two or more pharmacies within 180 days AND have a documented diagnosis of narcotic poisoning or drug abuse within the last 365 days.
• Violated a pain management agreement/contract with their prescriber.
• Prescriber, pharmacy, law enforcement referrals*

Members will be notified in writing that they will be subject to the lock-in program. Members can appeal the pharmacy lock-in decision within 60 days by following the procedures as outlined in the Appeals section in the Member handbook.

*Providers can refer members to our lock-in program if they suspect misuse, abuse, or potential fraud of pharmacy services. If you suspect member fraud, misuse, or abuse of services, you are encouraged to make a referral to the Pharmacy Lock-In program by calling the Fraud Tip Line at 1-866-833-9718.

Waiver Elimination (MAT Act)

• Section 1262 of the Consolidated Appropriations Act, 2023 (also known as Omnibus bill), removes the federal requirement for practitioners to submit a Notice of Intent (have a waiver) to prescribe medications, like buprenorphine, for the treatment of opioid use disorder (OUD). With this provision, and effective immediately, SAMHSA will no longer be accepting NOIs (waiver applications).

All practitioners who have a current DEA registration that includes Schedule III authority, may now prescribe buprenorphine for Opioid Use Disorder in their practice if permitted by applicable state law and SAMHSA encourages them to do so. SAMHSA and DEA are actively working on implementation of a separate provision of the Omnibus related to training requirements for DEA registration that becomes effective in June 2023. Please continue to check this webpage for further updates and guidance.

275 Annual Report

275 Annual Reports are no longer required or being accepted.

Co-prescribe Narcan