Kentucky SB 51 — prior authorization exceptions and safety edit procedures (pharmacy)
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Describes prior authorization requirements and exceptions for specified opioid use disorder and related medications in response to Kentucky Senate Bill 51 (effective July 1, 2021); affects Kentucky Medicaid pharmacy network dispensing and PA workflows for these products.
Certain buprenorphine products and Lucemyra will not require prior authorization for specified criteria effective July 1, 2021.
Safety edits required by the Federal SUPPORT Act remain in effect and most continue to require a PA to override.
Zubsolv quantity limits were changed to specific tablet daily limits (two 8.6 mg tablets and one 11.4 mg tablet per day).
Coverage Criteria and Scope
PA exemptions by product
Covered without prior authorization for the stated criteria when otherwise meeting clinical requirements.
Effective July 1, 2021; referenced in MedImpact notice.
Zubsolv and other listed buprenorphine products are included in the PA-exempt list effective July 1, 2021.
Listed explicitly as PA-exempt for clinical criteria effective July 1, 2021.
Methadone prescribed for the treatment of opioid use disorder is not affected by Kentucky Senate Bill 51 and continues to be dispensed only by methadone clinics.
This notice does not establish any additional conditions that would render these products not medically necessary. Standard MedImpact medical necessity policies and criteria remain in effect and continue to govern coverage determinations.
Provider Actions, Overrides, and Contact
Products exempted from certain PAs (effective 07/01/2021)
As of July 1, 2021, MedImpact will not require prior authorization for the following products and criteria when clinical requirements are met: Buprenorphine‑naloxone sublingual film (clinical, non‑preferred, and generic medically necessary criteria); buprenorphine sublingual tablet (generic for Subutex), Bunavail, Zubsolv, and Probuphine (clinical and non‑preferred criteria); and Lucemyra (clinical criteria). For providers, this means PA submissions are not needed for those specified criteria for these products beginning 07/01/2021.
No step therapy rules in this notice
This notice does not introduce any step therapy requirement changes. It only lists products exempted from certain prior authorizations and describes safety‑edit behaviors related to the Federal SUPPORT Act.
PA override process and documentation
Providers must follow MedImpact's standard PA processes when requesting an override of safety edits that remain in effect under the Federal SUPPORT Act; contact MedImpact's PA group for assistance and submit the documentation required by the PA process to support an override request.
- Follow MedImpact prior authorization submission and documentation procedures for safety‑edit overrides.
- Contact MedImpact PA support (phone/email) as needed per standard PA channels.
Safety edits that generally require a PA to override
Most safety edits mandated by the Federal SUPPORT Act require a prior authorization to be overridden.
- Duplicate fill alerts
- Early refill alerts
- Quantity limits
- Dosage limits
- MME limits
- Concurrent utilization reviews for opioids with benzodiazepines
- Concurrent utilization reviews for opioids with antipsychotics
Definitions and Safety Edit Summary
Quantity Limits and Specific Drug Limits
Background and Legislative Context
These updates implement changes driven by Kentucky Senate Bill 51 effective 07/01/2021, which remove prior authorization requirements for specified buprenorphine formulations and Lucemyra for the listed criteria. The notice also reiterates that federally required safety edits remain active and that certain pharmacy operational details (for example, methadone dispensing location and Zubsolv quantity adjustments) are unchanged or updated as noted.
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