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.
Click the selection that best matches your information needs.
- Frequently Asked Questions about Contract Year 2019 Formulary-Level Opioid Point-of-Sale Safety Edits [PDF, 94KB]
- Opioid-Tapering-Discontinuation-2019 [PDF, 69KB]
- Information for Patients [ZIP, 779KB]
- Information for Pharmacists [ZIP, 486KB]
- Information for Prescribers [ZIP, 718KB]
- Frequently Asked Questions about Part D Drug Management Programs (DMPs) [PDF, 162KB]
- Part D Drug Management Program Notices [ZIP, 982KB]
- 2019 OMS Technical Guidance (March 2019) [ZIP, 2MB]
- 2019 Part D Drug Management Program Policy Guidance Memo (November 20, 2018) [PDF, 367KB]
- Medicare Part D Spring Conference 2018 CARA_Opioid Presentation [PDF, 332KB]
- Oral MME CFs (vFeb 2018) [PDF, 83KB]
- Overutilization Contacts (02022019) [ZIP, 113KB]
- Medicare-PartD-Overutilization-Control-HPMS-memos (April 2019) [ZIP, 1MB]
- A Prescriber’s Guide to Part D Opioid Polices (2019) - Opens in a new window
- Fact Sheets for Patients - Opens in a new window
- Letter to Fee For Service Providers - Opens in a new window
- 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 Prescription Drug Eligibility and Enrollment - Opens in a new window
- Medicare Managed Care 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 (03182016) - 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
- NCPDP - Telecommunication Version D and Above - Questions, Answers, and Editorial Updates (November 2018) - 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: 05/13/2019 12:55 PM
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