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Medicaid Lock-in Program

If a member meets the criteria for the pharmacy and/or PCP Lock-In Program, the following initial communications are sent:

  • An intervention communication to the physician
  • A notification letter to the member
  • A notification letter to the pharmacy

Members will be enrolled into the Lock-In Program for a period up to 12 consecutive months (or longer if necessary to comply with state requirements). After this time frame, recipients will be released from the program.

  • Subsequent, ongoing communications with members, caregivers, prescribers, and pharmacies are based on how the member is managing within the Lock-In Program.
  • Members who are locked in are also referred to care management for further support and guidance for managing their pain.
  • If at any time if the limitation is determined not to be necessary, the member receives an alternative second notice indicating that the limitation has been removed.
  • Reevaluation will occur six months after the end of the initial lock-in period.
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Last Updated On: 12/13/2020