Medicare To Require Improved Care Coordination For Enrollees Using High-Dosage Opioids

In 2018, Medicare Advantage and Medicare Part D plans will be expected to improve care coordination for enrollees using high-dosage opioids. The plan sponsors will be expected to work with prescribing physicians to identify and employ best practices, and the most appropriate care management interventions for such beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) revised its Overutilization Monitoring System (OMS) potential overutilizer identification criteria to align with the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain. Plan sponsors are expected to implement safety edits, as either soft or hard claims edits . . .