New Prior Authorizations Required for Substance Use Disorder Prescriptions Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II.
What is 42 CFR Part II?
42 CFR Part II regulations prohibit the disclosure of patient records absent patient consent. Disclose means to communicate any information identifying a patient as being or having been diagnosed with a substance use disorder (SUD), having or having had a SUD, or being or having been referred for treatment of a SUD. Records include information regarding diagnosis, treatment, referral for treatment, billing information, emails, voice mails and texts. Withdrawal management means the use of pharmacotherapies to treat or attenuate signs and symptoms arising when heavy and/or prolonged substance use is reduced or discontinued.
New PA is Required for Patients Subject to 42 CFR Part II
To ensure a smooth transition of care during NC Medicaid Managed Care launch, plans were required to ingest existing PAs to reduce administrative burden and improve patient experience, with the exception of PAs subject to 42 CFR Part II. Providers will need to resubmit previously approved pharmacy PAs to the member’s new health plan.
NCTracks will be doing outreach to impacted providers who will need to resubmit authorization.
NCTracks Call Center: 800-688-6696