New Opiate and Benzodiazepine Coverage Limitations

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The 2021 North Dakota Legislative Assembly enacted North Dakota Century Code §65-05-40, to address quantity and duration limits for opioid and benzodiazepine therapies. Outlined below are the effective dates and general provisions of the new law.

Effective August 1, 2021, WSI will no longer cover a combination of opiate and benzodiazepine drugs. Additionally, new requests for coverage on the individual medications may not exceed:

  • Opioid therapy of 90 morphine milligram equivalents per day
  • More than a 7-day supply of opioid medication within a single outpatient transaction during the initial 30-day period of therapy
  • A cumulative duration of more than four weeks for benzodiazepine therapy

Effective July 1, 2022, an injured employee currently exceeding the above thresholds will need to be in compliance to maintain coverage for these drug therapies.

In order to exceed the outlined limitations, an injured employee will need to fall under one of the  exemptions listed in North Dakota Century Code §65-05-40 or undergo a review for medical necessity.

To assist in this transition, WSI will be sending correspondence  to all injured employees impacted by this change, creating informational resources for providers, and developing applicable treatment policy.

If you have questions about this article, please send an email to wsipr@nd.gov. Click here to sign-up to receive email notifications of the latest Medical Provider News. Make sure to follow us on Facebook and Twitter.

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