The Center for Medicare & Medicaid Services (CMS) 

OptumRx Medicare Plans

Effective January 1, 2017, CMS will require Medicare plan sponsors to implement a soft point of sale (POS) reject when an opioid prescription is presented following the initiation of buprenorphine for the treatment of opioid use disorder. An enhancement to the Drug-Drug Interaction (DDI) cDUR edit will be turned on to reject opioid claims when a member has a recent history of treatment with buprenorphine or buprenorphine containing products indicated for opioid dependence. If an opioid claim is submitted following an applicable buprenorphine claim at point of sale (POS), the claim will soft reject 88 with the following message:  

Hx of buprenorphine:CallMD,EnterO/R  

Note: The second half of the reject message may vary depending on the plan sponsor. 

Please see attached for more information.