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Reminder: CMS Requirements for Opioid Prescriptions

Thursday, January 31, 2019

Opioid-naïve members’ prescriptions

As a reminder, and in accordance with CMS requirements, per the Comprehensive Addiction and Recovery Act (CARA), CarePartners of Connecticut denies opioid-naïve members’ prescriptions exceeding seven days for acute pain.

This CMS requirement does not apply to members in active cancer treatment, hospice, long-term care (LTC), or palliative care.

Pharmacy point-of-sale drug utilization review (POS DUR) edits

As a reminder and, per CMS requirements, the following POS DUR edits are in effect. A consultation with the prescribing provider is necessary before a pharmacist can override and dispense:

  • Cumulative morphine milligram equivalent (cMME) dose limit across all opioid prescriptions (total daily doses exceeding 90 mg MME) must be reviewed by the prescribing provider
  • Drug-drug interaction between the concurrent use of an opioid and benzodiazepine
  • Duplicate long-acting opioids

Per CMS, prescribing providers are expected to respond to pharmacy outreach related to opioid safety alerts in a timely manner and to educate their back office and on-call staff.