Changes to Medicare plans for contract year 2019.
These are CMS’ new strategies to help Medicare Part D plans prevent and combat prescription opioid overuse through improved concurrent drug use review and became effective January 1. “There are changes to when a prescription can be filled, including several formulary-level opioid safety changes and modifications related to the point of sale,” says Ronna Hauser, PharmD, vice president of pharmacy policy and regulatory affairs at the NCPA. Medicare Advantage and Part D plans must follow this annual set of proposed rules, guidelines, and clarifications in order to participate in Medicare for the upcoming contract year.
One change, for example, is a care coordination safety edit. Under this edit, if a person’s cumulative morphine milligram equivalent (MME) per day across all of that person’s opioid prescriptions reaches or exceeds 90 MME, “sponsors should instruct the pharmacist to consult with the prescriber, document the discussion, and if the prescriber confirms intent, use an override code that indicates the prescriber has been consulted,” according to CMS.
“Combating opioid abuse has been at the forefront of the Trump Administration’s healthcare agenda and the Medicare Part D space is a federal program where many of the administration’s policy changes can make a difference,” Hauser tells Drug Topics. “CMS states that its formulary-level modifications seek to combat opioid abuse without impacting access to medically-necessary drugs and hindering a patient’s relationship with their healthcare team.”
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