This week's Advocacy Update includes information on changes to the DEA's registrant renewal process, resources for states regarding Medicaid reform, and much more!

Dear Valued Provider,

Effective January 1, 2017, Prime will be utilizing a new concurrent DUR (cDUR) service designed to help identify cases of Apparent Opioid Misuse. This service calculates the cumulative daily morphine equivalent dose (MED) across the submitted claim and selected historical claims. The service flags claims that would cause a Covered Person’s cumulative opioid medication use to exceed pre-defined thresholds of MED for consecutive days and associates with prescriptions from multiple Prescribing Providers filled by multiple Participating Pharmacies.

*Please see attached PDF for more information.

Effective January 1, 2017, CMS will require Medicare plan sponsors to limit the daily cumulative dose of opioid products a member may obtain at Point of Sale (POS). The daily limit is referred to as the Morphine Equivalent Dose (MED) limit. The cumulative limit is based on a combination of drug strength and a product’s Morphine Milligram Equivalency (MME). The cumulative total daily MED value will be calculated based on the number of opioid drugs prescribed over a period of time which includes incoming claims and active claims history. Depending on the plan, there may be multiple MED limits with varying response levels (Soft or Hard reject).

*Please see attached PDF for more information.

Please note some Blue Cross and HMO Louisiana members will follow a new "closed" formulary, or Covered Drug List, effective January 1, 2017.

The new Covered Drug List (closed formulary) includes thousands of generic and brand drugs; however, not every drug will be covered. When a wide range of successful, lower-cost alternatives are available, higher-cost drugs may not be covered for members whose plans follow our new Covered Drug List. Members with this formulary have received a letter from Blue Cross Blue Shield of Louisiana (BCBSLA) explaining the change and where to find the list: www.bcbsla.com/CoveredDrugs. Members may also call the Pharmacy number on their ID card: 866.781.7533.

*Please see attached PDF for more information.