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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. 

Under Construction: 2019 Guidance on Drug Management Programs and Other Updates Coming Soon 

Click the selection that best matches your information needs.  Please check back, as we will continue to update these resources regularly.