The Centers for Medicare & Medicaid Services (CMS) recently finalized new policies for Medicare drug plans to follow starting on January 1, 2019. A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 is one tool CMS is utilizing to strengthen and broaden partnerships with providers and prescription drug plans to address the opioid crisis. CMS believes providers are in the best position to identify and manage potential opioid overutilization in the Medicare Part D population with Medicare prescription drug plans assisting by alerting providers regarding unusual utilization patterns in prescription claims.
The new policies include improved safety alerts when opioid prescriptions are dispensed at the pharmacy and drug management programs to better coordinate care when chronic high-risk opioid use is present. Examples of alerts include a 7-day supply limit for opioid naïve patients and alerts when cumulative morphine milligram equivalent (MME) across all opioid prescriptions exceeds 90 MME.
Jayme Steig, PharmD, RPh, Great Plains QIN Quality Improvement Program Manager, states, “The start of the calendar year is always a hectic time for Medicare Part D beneficiaries and the prescribers and pharmacists providing care as many coverage changes take place on January 1. This year adds additional changes for those on opioids. It is important for providers to be aware of these changes to avoid disruption in medication delivery and safety providing pain medications.”
The new Medicare Part D opioid overutilization policies are a means to encourage interdisciplinary collaboration as well as care coordination among Part D plans, pharmacies, prescribers and patients in improving opioid utilization management, preventing opioid misuse, reducing serious adverse risks and promoting safer prescribing practices.
Great Plains QIN is also partnering with providers, pharmacists and stakeholders in the region to address the opioid crisis by providing learning opportunities, community coalition building and educational tools. Click here to learn more and how you can become involved in our efforts.