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Page 51 Wisconsin BadgerCare Reform Demonstration Approval Period: October 29, 2024 through December 31, 2029

month for opioids and some quantity limits for certain opioid products. There is a process in place for the pharmacy to receive an override in case a member needs to exceed the limits for clinically appropriate reasons. Expanded coverage of, and access to, naloxone for overdose reversal. 2013 Wisconsin Act 200 established expanded access to naloxone, allowing pharmacies to dispense naloxone via a standing order. In August 2016, DHS issued a statewide standing order allowing any pharmacy to use the order to dispense naloxone. Continue to monitor and evaluate. No immediate action. Wisconsin Medicaid covers Naloxone as a preferred drug and does not require prior authorization for coverage. In 2018, Wisconsin Medicaid expanded reimbursement policy to allow Opioid Treatment Programs to be reimbursed for dispensing naloxone. Implementation of strategies to increase utilization and improve functionality of prescription drug monitoring programs See attachment A for additional detail. See attachment A for additional detail. See attachment A for additional detail.

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Page 52

Official source

Page 51 Wisconsin BadgerCare Reform Demonstration Approval Period: October 29, 2024 through December 31, 2029

month for opioids and some quantity limits for certain opioid products. There is a process in place for the pharmacy to receive an override in case a member needs to exceed the limits for clinically appropriate reasons. Expanded coverage of, and access to, naloxone for overdose reversal. 2013 Wisconsin Act 200 established expanded access to naloxone, allowing pharmacies to dispense naloxone via a standing order. In August 2016, DHS issued a statewide standing order allowing any pharmacy to use the order to dispense naloxone. Continue to monitor and evaluate. No immediate action. Wisconsin Medicaid covers Naloxone as a preferred drug and does not require prior authorization for coverage. In 2018, Wisconsin Medicaid expanded reimbursement policy to allow Opioid Treatment Programs to be reimbursed for dispensing naloxone. Implementation of strategies to increase utilization and improve functionality of prescription drug monitoring programs See attachment A for additional detail. See attachment A for additional detail. See attachment A for additional detail.