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New Medicare Part D Opioid Management Policies Took Effect January 1
Posted on: 1/28/2019

Prescribers may experience an uptick in calls from pharmacists

As the nation's opioid crisis continues, a new rule from the Centers for Medicare and Medicaid Services (CMS), which took effect Jan. 1, 2019, seeks to reduce potential instances of opioid overutilization. 

The new rule imposes these new pharmacy dispensing guidelines:

  • Pharmacies may not dispense more than a seven-day supply for an initial opioid prescription without an override or Medicare Part D plan authorization. If a patient needs more than a seven-day supply, a prescriber will need to contact the Medicare Part D plan and attest that the supply is medically necessary. Please note: Subsequent prescriptions aren’t subject to these limits. 

  • Pharmacies will be alerted when a patient’s cumulative dosage of morphine milligram equivalents (MME) across all prescriptions, prescribers and pharmacies exceeds 90 MME. The pharmacist will contact the prescriber whose prescription triggered the alert to review and approve the order. 

  • Pharmacies will be alerted when a patient has concurrent prescriptions for opioids and benzodiazepines. The pharmacist is expected to do additional safety reviews and may contact the prescriber(s) to determine the appropriateness of the concurrent medications.

To learn more, check out CMS'  Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019. Additional information about these and other Medicare Part D opioid management policies is available from CMS.

Questions? Contact Corey McGee at 800-782-4767, ext. 6525 or by email.  



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