CMS Guidance To States & Medicaid MCOs Recommends Tracking Opioid Use & Setting Prescription Limits

On August 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid fee-for-service (FFS) programs and Medicaid managed care organizations (MCOs) on using claims review edits to track opioid use and set prescription limits. The guidance is intended to help states implement new Medicaid Drug Utilization Review (DUR) provisions included in the "Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act” (SUPPORT Act). Under these provisions, the states must establish new drug review and utilization standards to reduce opioid-related fraud, abuse, and misuse. By October 1 . . .