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:
- Drug Management Programs, codified in the 2019 Parts C & D Final Rule. https://www.gpo.gov/fdsys/pkg/FR-2018-04-16/pdf/2018-07179.pdf.
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.
- Improved Opioid Safety Alerts announced in the 2019 Medicare Parts C&D Final Call Letter. https:///Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.
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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