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.
The CMS advises, “As the new opioid safety alerts are implemented in 2019, on-going communication among the pharmacist, the Part D plan, and the prescriber will be critical. Physicians and other prescribers can protect their patients’ access to medically necessary drugs by responding to pharmacists’ or plan sponsors’ telephone calls or case management notices. Providers will also want to initiate coverage determinations or exceptions, when clinically appropriate. To avoid a prescription being rejected at the pharmacy, prescribers may proactively request a coverage determination in advance. The time frame for an expedited coverage determination request applies when the prescriber indicates, or the plan decides, that applying the standard time frame may seriously jeopardize the enrollee’s life, health, or ability to regain maximum function. If the request meets the criteria for an expedited review by the plan, the plan must make its decision and notify the patient as expeditiously as their health condition requires, but no later than 24 hours after receipt of the request.”