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Improving Drug Utilization Review Controls in Part D

Medicare Part D sponsors must manage drug overutilization within their prescription drug plans as described in the Final CY 2013 Call Letter.  The Improving Drug Utilization Review Controls in Part D website contains information to help Part D sponsors create or change their programs to address the unsafe use of opioid pain medications.  This website also contains CMS communications to Part D sponsors regarding:

  • Drug utilization management (DUM) guidance regarding the control of opioid and acetaminophen overutilization.
  • The Overutilization Monitoring System (OMS), which helps CMS ensure that sponsors have established reasonable and appropriate drug utilization management programs to assist in preventing overutilization of certain prescribed medications.
  • Sponsor Overutilization Beneficiary-level POS edit notifications reported to CMS through the mailbox and the Medicare Advantage Prescription System (MARx) Point-of-Sale (POS) Edit database, which collects beneficiary-level opioid POS edit information from sponsors for overutilizers identified in their plans and notifies a sponsor if a newly enrolled beneficiary had an active opioid POS edit while enrolled in the immediately preceding Part D contract. 


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