Narcotic Lock-in Program

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:
    • 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 Health Benefits (DHB).