Rule 4123-6-21.5 | Standard dose tapering schedules.
(A) The bureau hereby adopts the standard dose tapering (weaning) schedules for the prescription medications indicated in this rule, and the appendix to this rule.
(B) These weaning schedules apply to denials for payment of the indicated medications by the bureau, self-insuring employers, MCOs, QHPs, and the industrial commission when:
(1) The medication has been previously allowed for treatment of an allowed condition in the claim;
(2) The denial is based upon a finding that the medication is no longer medically necessary or appropriate for treatment of the allowed condition; and
(3) The prescriber has submitted a written treatment plan reflecting an intention to discontinue the medication and a request for reimbursement of the weaning period.
(C) The approved weaning duration will be the weaning period requested by the prescriber, or the weaning period outlined in this rule or the appendix to this rule, whichever is less.
(D) Weaning from opioids: Upon denial of reimbursement for an opioid, reimbursement for a weaning period will only be approved if the prescribed total daily morphine equivalent dose is sixty or greater.
(1) The approved duration of the opioid weaning period must allow for a ten percent reduction of the total daily morphine equivalent dose per week, or a larger reduction with a shorter duration as requested by the prescriber.
(2) Requests to approve additional time for weaning for rates slower than a ten per cent dose reduction per week will be denied.
(E) Weaning from benzodiazepines: The weaning period for benzodiazepines is set forth in the appendix to this rule.
Last updated February 1, 2022 at 9:33 AM
Supplemental Information