Prescription Template

To facilitate the prescribing of naloxone , DHMH created a template with sample prescriptions, which can be printed on Avery(R) 22823 Pearlized Rectangular 3x3 labels (Item:985647; Model: 22823) and affixed to individual prescriber’s prescription pads.

 

Patient Counseling

Patients who are prescribed naloxone by their provider are not required to be trained and certified under the ORP. However, it is important that patients are provided information and counseling on how to recognize the symptoms of opioid overdose and response with naloxone.

 

There are a number of patient counseling materials available online, including:

·         ORP Core Curriculum​ contains much of the information a patient will need

·         getnaloxonenow.org provides a free, interactive online overdose response training

·         prescribetoprevent.org provides patient education, videos, and additional overdose prevention education materials

·         Additional patient resources are available here​.


Family and caregivers should be included, when possible, in patient counseling.  If they are not available then the patient should be instructed to train others in case of an overdose.  

 

Billing for Patient CounselingAccording to the SAMHSA Opioid Overdose Toolkit: Information for Prescribers, the codes for Screening, Brief Intervention, and Referral to Treatment (SBIRT) can be used to bill time for counseling a patient about how to recognize overdose and how to administer naloxone. Billing codes for SBIRT include those listed below.  Additional information for prescribers can be found in the SAMHSA Toolkit.

·         ​Commercial Insurance: CPT 99408 (15 to 30 minutes)

·         Medicare: G0396 (15 to 30 minutes)

·         Medicaid: H0050 (per 15 minutes)

 

Maryland Medicaid Billing and Formulary Status

Effective October 1, 2014, naloxone hydrochloride is carved-out of the HealthChoice managed care benefit and covered by Medicaid fee-for-service (BIN 610084, PCN RMDPROD, Group ID MDMEDICAID). Claims should be processed as fee-for-service, just as claims for other carved-out drugs such as mental health drugs and antiretroviral.  There is a $1 copay for generic naloxone hydrochloride, and $3 copay for Evizo auto-injector (requires pre-authorization). However, pharmacies may not deny service to any recipient if they are not able to pay the copay (COMAR 10.09.03.03 (M)). The durable medical equipment (DME) associated with naloxone administration has also been carved out, which includes the nasal mucosal atomizer device (MAD 300) and syringes. A list of pharmacies that are authorized to bill Medicaid for DME dispensing is available online.​