§ 65-05-40 — Opioid therapy and benzodiazepine duration limits - Termination of coverage

coverage.
1. The organization may not pay for opioid therapy that exceeds ninety morphine
milligram equivalents of opioid medication per day, or more than a seven-day supply of
an opioid medication within any single outpatient transaction during the initial thirty-day
period of opioid therapy.
a. The limitations do not apply to:
(1) Opioid therapy prescribed for active and aftercare cancer treatment;
(2) End-of-life and hospice care;
(3) Treatment for substance use disorder;
(4) An emergency room setting;
(5) An inpatient hospital setting;
(6) A long-term care facility setting; or
(7) An assisted living facility setting.
b. Opioid therapy includes controlled substances listed in subsections 3 and 4 of
section 19-03.1-07, subsection 6 of section 19-03.1-09, subsection 3 of section
19-03.1-11, subsections 3 and 4 of section 19-03.1-13, or any substance with
similar properties or affects.
2. The organization may not pay for benzodiazepine therapy beyond a cumulative
duration of four weeks, except when approved by the organization for the treatment of
an anxiety disorder. Benzodiazepine therapy includes controlled substances contained
in subdivisions a, i, j, k, l, p, r, v, x, ee, mm, qq, xx, yy, aaa, and ccc of subsection 4 of
section 19-03.1-11, or any substance with similar properties or affects.
3. The organization may not pay for any combination therapies that include controlled
substances from subsections 1 and 2 concurrently.
4. A review of requests to depart from the established limits in subsections 1, 2, and 3,
upon a showing of medical necessity, are dispute resolution decisions under section
65-02-20.