Improving Drug Utilization Review Controls in Part D

The Improving Drug Utilization Review Controls in Part D website contains information about the Medicare Part D opioid overutilization policies including:

As required by the Comprehensive Addiction and Recovery Act (CARA), in this final rule, CMS finalized the framework under which Part D plan sponsors may adopt drug management programs (DMPs) beginning January 1, 2019 for beneficiaries who are at-risk of misusing or abusing frequently abused drugs (FADs). The rule codified many aspects of the retrospective Part D Opioid Drug Utilization Review (DUR) Policy and the Overutilization Monitoring System (OMS), with adjustments as needed to comply with CARA, by integrating them into the DMP provisions.

Effective January 1, 2019, CMS announced new strategies to further help Medicare Part D sponsors prevent and combat opioid overuse including additional safety alerts at the time of dispensing as a proactive step to engage both patients and prescribers about overdose risk and prevention. 


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Page Last Modified:
05/18/2021 07:19 PM