CMS Proposes Part D Opioid Limits, Pharmacy Reacts


Pharmacy groups are praising new Medicare Part D opioid limits.

The Centers for Medicare & Medicaid Services’ new Medicare Part D proposal calls for a seven-day supply limit on opioid prescriptions and other efforts to help battle the opioid epidemic.

The new proposal, which would go into effect in 2019, includes new hard formulary levels at pharmacies that would restrict the amount of initial fills on prescription opioids to seven days for the treatment of acute pain with or without a daily dose maximum (such as 50 MME).

CMS would also expect all sponsors to implement soft POS safety edits (which can be overridden by a pharmacist) based on duplicative therapy of multiple long-acting opioids, and request feedback on concurrent prescription opioid and benzodiazepine soft edits, the agency said in a fact sheet about the proposal.

Related article: The Other Side of Opioid Limits

CMS also proposes enhancing the Overutilization Monitoring System (OMS) by identifying high risk beneficiaries who use “potentiator” drugs such as gabapentin (brand names Neurontin, Gralise, and others) and pregabalin (brand name Lyrica) in combination with prescription opioids to “ensure that plans provide appropriate case management,” CMS said.

OMS already flags concurrent benzodiazepine use by plan enrollees.

While NACDS executives have not been able to fully review the proposal, the organization in general advocates for “a change in public policy to create a seven-day supply limit for initial opioid prescriptions issued for acute pain, which is consistent with the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain,” Chris Krese, spokesman for NACDS, told Drug Topics.

“CDC’s clinical evidence suggests that a greater amount of initial opioid exposure is associated with a greater risk for long-term use and addiction. More than 20 states already have taken action, and federal action is needed for consistent patient care,” Krese added.

Meanwhile, NACDS is reviewing the exact details of CMS' Medicare Part D, to determine if they are consistent with NACDS’s position. “Following that review, NACDS will submit comments to CMS,” Krese said.

Related article: CVS Limits Opioid Use

In related news, the National Conference of Pharmaceutical Organizations (NCPO) called for “immediate action on components of the President’s Commission on Combating Drug Addiction and the Opioid Crisis report” and requested the opportunity to dialogue with the President and others in the Administration for continued collaboration on opioid-related issues.

The coalition of 11 trade associations and professional societies includes NACDS, NCPA, ASHP, and APhA.

“Pharmacy has significant insights about the complexity of this issue, given the role of pharmacists on the front lines of healthcare every day, and we are committed to working proactively with NCPO members and with all levels and branches of government for the safety of our families and communities,” said NACDS President and CEO Steven C. Anderson.

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