1. As used in this section, "chronic opioid therapy" is opioid treatment extending beyond ninety days from initiation which is for the treatment of pain resulting from a nonmalignant, compensable condition or therapies for another nonterminal compensable condition. 2. In order to qualify for payment for chronic opioid therapy: a. Chronic opioid therapy must result in an increase in function, enable an injured employee to resume working, or improve pain control without debilitating side effects; b. Chronic opioid therapy must treat an injured employee: (1) Who has been nonresponsive to non-opioid treatment; (2) Who is not using illegal substances or abusing alcohol; and (3) Who is compliant with the treatment protocol; and c. The prescriber of chronic opioid therapy shall provide to the organization: (1) At least every ninety days, documentation of the effectiveness of the chronic opioid therapy, including documentation of improvements in function or improvements in pain control without debilitating side effects; and (2) A treatment agreement between the injured employee and the prescriber which restricts treatment access and limits prescriptions to one identified single prescriber. This paragraph does not preclude temporary coverage within a single clinic by an identified prescriber when the prescriber of record is unavailable and does not preclude a referral to a pain specialist. 3. At the prescriber's or organization's request, an injured employee on chronic opioid therapy is subject to random drug testing for the presence of prescribed and illicit
substances. Failure of the test or of timely compliance with the request may result in termination of chronic opioid therapy coverage. 4. Failure to comply with any of the conditions under this section may result in the termination of coverage for chronic opioid therapy.
65-05-40. Opioid therapy and benzodiazepine duration limits - Termination of coverage. 1. The organization may not pay for opioid therapy that exceeds ninety morphine milligram equivalents of opioid medication per day, or more than a seven-day supply of an opioid medication within any single outpatient transaction during the initial thirty-day period of opioid therapy. a. The limitations do not apply to: (1) Opioid therapy prescribed for active and aftercare cancer treatment; (2) End-of-life and hospice care; (3) Treatment for substance use disorder; (4) An emergency room setting; (5) An inpatient hospital setting; (6) A long-term care facility setting; or (7) An assisted living facility setting. b. Opioid therapy includes controlled substances listed in subsections 3 and 4 of section 19-03.1-07, subsection 6 of section 19-03.1-09, subsection 3 of section 19-03.1-11, subsections 3 and 4 of section 19-03.1-13, or any substance with similar properties or affects. 2. The organization may not pay for benzodiazepine therapy beyond a cumulative duration of four weeks, except when approved by the organization for the treatment of an anxiety disorder. Benzodiazepine therapy includes controlled substances contained in subdivisions a, i, j, k, l, p, r, v, x, ee, mm, qq, xx, yy, aaa, and ccc of subsection 4 of section 19-03.1-11, or any substance with similar properties or affects. 3. The organization may not pay for any combination therapies that include controlled substances from subsections 1 and 2 concurrently. 4. A review of requests to depart from the established limits in subsections 1, 2, and 3, upon a showing of medical necessity, are dispute resolution decisions under section 65-02-20.