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2019 changes to the Medicare Part D opioid program

We’re committed to working with providers to better manage the use of opioids. To this end, we’re implementing a drug management plan. The plan is in accordance with recommendations made by the Centers for Medicare & Medicaid Services (CMS) in the 2019 Call Letter. It includes: 

  • Point of sale (POS) safety edits
  • Increased access to medication-assisted treatment and opiate overdose reversal agents


Safety reviews of opioid prescriptions at point of sale

For 2019, there are several edits that will trigger a safety alert for the pharmacist to review. Most times, the pharmacy can contact us to place an override to allow the prescription to process. But in some cases, the pharmacist may need to contact you for clarification. Please promptly respond to these requests to determine if the prescription can be filled.



How you can help

For opiate-naïve patients, limit prescriptions to less than seven days. Encourage your patients to get their opioid prescriptions from one provider. Use caution with multiple opioids. Avoid the use of benzodiazepines or buprenorphine with opioids.


We rely on provider and pharmacy input. Please respond when pharmacies ask for clarification and guidance. We will continue to provide ongoing education to providers and pharmacies.