Dear Pharmacy Partner,

Below is an update from our prior January 6, 2017 email communication regarding changes to our Opioid Morphine Equivalent Dose (MED) program that placed edits at the point of sale. 

Dear Pharmacist and/or Support Staff,

In March of 2016, the Centers for Disease Control and Prevention (CDC) released the Guideline for Prescribing Opioids for Chronic Pain. The summary of evidence demonstrates that the risk of opioid use greatly outweighs the benefit for the majority of patients. Their in-depth review echoed conclusions drawn by many other organizations – the benefit gained from the long-term use of opioids for chronic, non-cancer pain, does not outweigh the associated risks of using the medication. Population studies of death rates and prescribing practices demonstrate a close relationship between the amount of opioids prescribed and deaths related to their use. In short, there is inadequate evidence to support long-term opioid use for chronic, non-cancer pain.

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.

*Please see attached PDF for more information.

Please be advised that, effective 1/1/2017, MedImpact will be implementing new POS edit functionality to support mandatory 2017 CMS requirements for Medicare Part D claims processing.

MedImpact is providing this advanced notice to our Network Pharmacy Partners to:

1.      Inform pharmacies about the scope and intent
2.      Educate pharmacies regarding claims processing, reject messaging and override capabilities
3.      Allow pharmacies the opportunity to update pharmacy software configurations, as needed

Please see attachment for more information.

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: