Additional clarification regarding the cumulative Morphine Equivalent Dose (MED) limit that was effective 1/1/2017.

To comply with new regulations from the Centers for Medicaid and Medicare Services (CMS), most Medicare Part D Plans and some commercial plans will be implementing new edits to help manage opioid use within their Medicare populations.

*Please see attached PDF for more information.

Effective 1/1/2017, the Morphine Equivalent Dose (MED) edit will be upgraded from messaging only to a soft rejection with messaging for all Navitus clients. The MED edit identifies members who have active opioid prescriptions with a cumulative morphine equivalent dose of 120 mg or greater, prescribed by two or more providers, and filled at two or more pharmacies. The purpose of this edit is to alert the dispensing pharmacist of potential overutilization issues. The soft rejection will allow for a pharmacist to review the clinical appropriateness of the claim, perform any prescriber outreach (as applicable), and, when clinically appropriate, override the rejection at the point-of-sale using standard NCPDP DUR codes. In addition to the soft rejection, pharmacies will receive the following message: "High Morphine Eq Dose, Mult Prescriber/Pharmacy."