Effective January 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: 
 
History of buprenorphine:Call MD,Enter O/R 
 

If the Soft reject occurs, the pharmacist can override the reject using appropriate DUR/PPS Reason, Professional, and Result codes. Consultation with and approval from the prescriber are required prior to using the PPS codes. For this scenario, please see the attached code combination.