MedicaidCoverageHigh impact
Florida Statute 456.44(5)(a) Opioid Days' Supply Limitation (Revised)
Humana·FL · Pain Management, Palliative Care, Oncology +6 more·Medicaid
Effective date
Nov 27, 2024
We identified it
Jun 25, 2026
Summary
Florida Medicaid updated its opioid days' supply limitation policy effective November 27, 2024. Schedule II opioids for acute pain are limited to 3 days (or 7 days with documented exception), Schedule III-V opioids to 14 days for acute pain, and all opioids to 30 days for non-acute/chronic pain. Prescribers must indicate 'Acute Pain Exception' or 'Non-Acute Pain' on prescriptions to override defaults, and certain diagnoses (cancer, sickle cell, hospice, terminal illness, serious traumatic injury) are excluded from acute pain limitations.
Action Required
By December 27, 2024: (1) Billing and pharmacy teams must update point-of-sale (POS) system edits and claim adjudication rules to enforce the revised opioid quantity limits: Schedule II acute pain = 3-day default/7-day with exception; Schedule III-V acute pain = 14-day limit; non-acute pain = 30-day limit for all schedules. (2) Update claim rejection/denial logic to flag prescriptions missing 'Acute Pain Exception' or 'Non-Acute Pain' indicators. (3) Communicate with all prescribers in network regarding documentation requirements for acute pain exceptions and medical record justification standards. (4) Update prior authorization workflows to identify claims that meet exclusion criteria (cancer, sickle cell, CNMP, hospice, terminal illness, serious traumatic injury with ISS ≥9) and bypass quantity limits accordingly. (5) Front desk and prior auth staff must train on recognizing valid exception indicators on prescriptions. Failure to implement will result in claim denials and provider frustration; claims submitted without proper indicators may be automatically rejected at adjudication.