http://amcp.org/WorkArea/DownloadAsset.aspx?id=16164

Drug Class Quantity Limits (page 139)
CMS’ 2013 call letter indicated that it would develop a submission mechanism for QLs
based on cumulative morphine equivalent dose (MED) for the opioid class of agents.
CMS has indicated that in 2014 the health plan management system (HPMS) submission file record will accept cumulative MED QLs for review. CMS seeks comment regarding the MED level that could be implemented at the point of sale (POS) . CMS seeks to balance a MED level that ensures safety but does not inappropriately restrict access to medically necessary drugs. CMS has previously suggested a cumulative MED level of greater than 120 mg as a component of a targeting approach for retrospective drug utilization review (DUR) and case management, and seeks input on the appropriate MED level to allow rejection of claims at POS. CMS will likely publish additional information in the final Call Letter

It would seem that CMS has been putting together a “STAR PROGRAM” for Part D programs .. including pharmacies… reportedly the primary function of this program is improved compliance and outcomes for a handful of particular chronic conditions… hypertension, cholesterol, diabetes and COPD/COLD/ASTHMA.. A lot of it seems to be focused on those > 65 y/o and trying to avoid them from taking drugs that are listed on

Beers Criteria (Medication List)

Potentially Inappropriate Medications for the Elderly
According to the Revised Beers Criteria (2012)

While it appears that chronic pain is not one of the listed chronic diseases that this program is going to focus on.. it is however… going to put a Morphine mgs daily equivalent of 120 mg in the program. In my personal opinion.. this MAY provide adequate pain management for those with mid-moderate pain… you can forget those with severe pain getting adequate pain management at this mg/day level.

Filed under: General Problems