Appendix 1.

Policy type definitions

Term	Definition
Guideline/recommendation	Provides a recommended threshold over which prescribers should not exceed or should only exceed if special precautions are taken. Guidelines/recommendations have no mechanism of enforcement.
Rules/regulations	Similar to guidelines, but are stated as an imperative (e.g., “must” “shall”) and may or may not have an explicit means of enforcement.
Legislative Act	Similar to guidelines, but are stated as an imperative (e.g., “must” “shall”) and may or may not have an explicit means of enforcement.
Legislative Act	Any law passed by the state’s legislative body which has gone into effect. Proposed bills that never became law are not included.
Alert System/Automatic Patient Report	A mechanism by which targeted, unsolicited letters or alerts sent either by mail or electronically and inform prescribers that patients under their care have exceeded a given MEDD threshold. Follow-up action may or may not be required.
Prior Authorization	A requirement that mandates prior approval from a third party before prescriptions above a given MEDD threshold may be filled.
Claim Denial	A mechanism by which a third party denies prescription fills above a given MEDD threshold. In cases where Prior Authorization documentation explicitly states that prescriptions above a given MEDD threshold will not be approved, Prior Authorization and Claim Denial may be coded as two distinct policies.