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Prescribers, New Medicare Part D Opioid Management Policies Went Into Effect Jan. 1. Here’s What You Should Know

January 22, 2019

As the nation’s opioid crisis continues, a new rule from the Centers for Medicare and Medicaid Services (CMS) effective Jan. 1 seeks to reduce potential instances of opioid overutilization.

Be aware of following new pharmacy dispensing guidelines:
  • Pharmacies may not dispense more than a seven-day supply for an initial opioid prescription without an override or Medicare Part D plan authorization. If a patient needs more than a seven-day supply, a prescriber will need to contact the Medicare Part D plan and attest that the supply is medically necessary. NOTE: Subsequent prescriptions aren’t subject to these limits.
     
  • Pharmacies will be alerted when a patient’s cumulative dosage of morphine milligram equivalents (MME) across all prescriptions, prescribers and pharmacies exceeds 90 MME. The pharmacist will contact the prescriber whose prescription triggered the alert to review and approve the order. 
     
  • Pharmacies will be alerted when a patient has concurrent prescriptions for opioids and benzodiazepines. The pharmacist is expected to do additional safety reviews and may contact the prescriber(s) to determine the appropriateness of the concurrent medications.
To learn more, here’s a backgrounder to share with your team. Additional information about these and other Medicare Part D opioid management policies is available from CMS.
For additional questions, contact Corey McGee at 800-782-4767 or by email.  
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