Narcotic Lock-in Program
State program restricting Medicaid recipients identified for “lock-in” to a single prescriber and pharmacy for obtaining certain frequently abused medications.
- Program initiated by N.C. Medicaid to support the state’s development of procedures for controlling recipients’ over-utilization of benefits.
- N.C. Medicaid recipients identified for the program are restricted to a single prescriber and a single pharmacy for obtaining:
- Opioid analgesics
- Certain anxiolytics covered through the N.C. Medicaid Outpatient Pharmacy Program
- N.C. Medicaid recipients will be locked into one prescriber and one pharmacy for the above controlled substances if one or more of the following criteria are met:
- For benzodiazepines and certain anxiolytics: Medicaid beneficiary has more than six claims in two consecutive months
- For opiates: Medicaid beneficiary has more than six claims in two consecutive months
- Medicaid beneficiary has received prescriptions for opiates and/or benzodiazepines and certain anxiolytics from three prescribers in two consecutive months
- Medicaid beneficiaries who qualify for the program will be locked-in for one year, after which they will be removed from the program should they no longer meet the criteria; beneficiaries who continue to meet the criteria after that initial year will be locked-in for a subsequent year. Should a beneficiary meet the criteria again after being released from the program, he or she will be re-identified for inclusion.
- Once a Medicaid beneficiary is locked-in, he or she may not change the lock-in prescriber or pharmacy without authorization from the NC Division of Medical Assistance (DMA).