MME Edit Coming in Early 2019

The Alabama Medicaid Agency is working on implementing Morphine Milligram Equivalent (MME) edits in early 2019. Higher doses of opioids are associated with higher risk of overdose and death – even relatively low dosages (20-50 MME per day) may increase risk. Therefore, beginning in early 2019, Alabama Medicaid will limit the amount of cumulative MME’s allowed per day on opioid claims. The edit will begin at 250 cumulative MME per day and will gradually decrease over time. The final MME target will be 90 MME per day. Claims for opioids that exceed the maximum daily cumulative MME limit will be denied.

Claims prescribed by oncologists will bypass the edit. Long-term care, hospice patients, and children will also be excluded.

Overrides for quantities exceeding the MME limit may be submitted to Health Information Designs (HID). Information regarding override requirements and MME examples will be made available on the Alabama Medicaid Agency website closer to the implementation of the
new limitations. Additional information will be disseminated to all impacted providers through a provider ALERT closer to
implementation; please check the Alabama Medicaid Pharmacy webpage for additional information.

For more information: http://www.medicaid.alabama.gov/content/4.0_Programs/4.3_Pharmacy-DME.aspx