DUR Edits: Payer has edits to ensure dosage accuracy and to promote patient safety and prevent overutilization. Some of these edits may be overridden by the pharmacy at the Point of Sale. Contact the Pharmacy Technical Help Desk for assistance with entering overrides.

MEDLIMIT: CMS requires Medicare plan sponsors to limit the daily cumulative dose of opioid products a member may obtain at Point of Sale (POS). The edit in place assesses the total daily morphine equivalent dose of opioid medications (MED). The edit identifies single incoming claims of concern, as well as overlapping claims within the members' history. The total daily MED across identified claims is then calculated using a conversion factor for each opioid product. The edit will be triggered if the total calculated MED exceeds the threshold defined by the edit setup in the PBM.

* Please see attachment for more information.