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://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html.
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.
Under Construction: Additional Documents Coming Soon
- Coming soon: 2019 Opioid Safety Edit Guidance
Click the selection that best matches your information needs. Please check back, as we will continue to update these resources regularly.
- Announcements and Documents - Centers for Medicare & Medicaid Services - Opens in a new window
- Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program - Opens in a new window
- MAPD Plan Communications User Guide (PCUG) - Opens in a new window
- Medicare Managed Care Eligibility and Enrollment - Opens in a new window
- Medicare Prescription Drug Eligibility and Enrollment - Opens in a new window
- Prescription Drug Benefit Manual - Opens in a new window
- CDC Guideline for Prescribing Opioids for Chronic Pain (10012018) - Opens in a new window
- Analyzing Prescription Data and Morphine Milligram Equivalents (MME) - Opens in a new window
- Resource Center | Drug Overdose | CDC Injury Center - Opens in a new window
- CMS Opioid Roadmap - Opens in a new window
- HHS page - Opens in a new window
- Part C and D Performance Data - Opens in a new window
- Page last Modified: 10/19/2018 3:12 PM
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