Effective 5/1/25: HHSC Revisions to the Uniform Opioid Policy

Date: 03/20/25

Please Note: This article has been updated since the last time this was posted on February 17,2025.

Superior HealthPlan follows the Texas Health and Human Services Commission (HHSC) Uniformed Managed Care Manual (UMCM) rules. HHSC is updating the Uniform Opioid Policy in UMCM Chapter 16.1 to address Centers for Medicare and Medicaid Services (CMS) compliance.

Please note the following:

• Effective May 1, 2025, all opioid prescriptions will be limited to a 10-day supply for initial and subsequent fills for members who are considered opioid naïve. Subsequent fills for members who are no longer opioid naïve may receive up to a 31-day supply.
  • The requirement in 42 CFR §456.703 specifies that programs must have safety quantity limitations in place on opioid prescriptions for initial and subsequent prescriptions fills.
  • Prior authorization may still be needed if dosed over 90MME daily. 
  • For more information please review HHSC’s Texas Medicaid and CHIP – Uniform Managed Care Manual webpage after May 1, 2025.
• Please work with your patients who may be using opioids for chronic pain to ensure they are aware of this upcoming change.

If you have any questions please reach out to Superior Pharmacy Services at 1- 866-768-7147, ext. 6081112.

You can also contact your local Provider Representative. To access their contact information visit Find My Provider Representative.