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Dr Crescent Moore Outlines CMS' Efforts to Address the Opioid Epidemic
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Dr Crescent Moore Outlines CMS' Efforts to Address the Opioid Epidemic

Crescent Moore, PharmD, PhD, BCPS, senior consultant, BluePeak Advisors, explains efforts by CMS to address the opioid epidemic put forward by their 2020 Call Letter.

Crescent Moore, PharmD, PhD, BCPS, senior consultant, BluePeak Advisors, explains efforts by CMS to address the opioid epidemic put forward by their 2020 Call Letter.


CMS’ 2020 Call Letter included actions in response to the opioid crisis. What efforts are included in the call letter to address the epidemic?

In 2020, CMS expects for plan sponsors to continue those point of sale safety edits that were implemented in 2019. Also, CMS does remind plans that although the drug management program is optional in 2020, it will be mandatory for all contracts in 2022. So, I would really encourage plan sponsors to really, if they did not implement one for 2019, to start looking at what they need to do to be ready, if not in 2020, but definitely for 2022. From a Part C perspective, CMS reminded Medicare Advantage organizations that they are allowed to cover medically approved, non-opioid pain therapies. So, that’s something that as plan sponsors start to do their part and really think about other ways that they can help tackle the opioid epidemic, that they can start expanding those benefits and looking at what they’re currently covering; is there anything additional they can?

From a Part D perspective, as I mentioned, we’re still continuing those point of sale edits. CMS did remind folks that we do need to have the point of sale edits to remind pharmacists of duplicative opioid therapies, as well as concurrent use of opioids with a potentiator such as a benzodiazepine. Also, on the Part D side, CMS is recommending that plan sponsors look at where they’re putting their agents such as Narcan and Naloxone on their formularies. They’d really like to see those agents on as low of a tier as possible, even potentially at a $0 cost-shared tier.

Finally, medication therapy management is really being pushed to help address the opioid epidemic. So, CMS really would like to see plan sponsors incorporate members who are at risk to be an opioid overuser or who are taking that combination of an opioid and say a benzodiazepine or some other potentiator, be incorporated into your medication therapy management program. I really encourage plans as they consider that to really think about what their filing will look like when they file their application so that they have everything correct because, at the end of the day, there is a star measure around medication therapy management, and you want to make sure you have everything in place.

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