Can CMS Fight The Opioid Crisis With Medicare Changes?

Ned Mumtaz
Written By
Ned Mumtaz
February 5, 2018

February might prove to be a definitive month for CMS, as it proposes changes to its Medicare Health and Drug Programs, effective 2019. The changes are predicted to make Medicare Advantage more flexible, providing beneficiaries with more options and benefits. Motivating these changes is CMS’ goal of fighting the opioid crisis by revitalizing the doctor-patient communication/relationship.

What’s Set To Change

Senior citizens will be able to enjoy a wider range of options, and lowered payments for premiums as part of their Medicare Health/Drug Plans.  The CMS has widened the definition of supplemental benefits to include assistive devices, portable wheelchair ramps, non-skilled in-home supports and others, a departure from its previous definition of supplemental benefit, which limited items to non-daily maintenance.

How does this work for the opioid crisis?  Enrollees in the Medicare Part D Program will continue to be subject to regulatory circumspection, with added action by way of reducing overutilization by enrollees. In other words, monitoring mechanisms will be ‘tightened up.’

The change comes as part of CMS’ OMS or Overutilization Monitoring System, which identifies high-risk points of opioid abuse. Under the new mechanisms, users who abuse drugs in addition to opioids will also be flagged.

Ned Mumtaz

About the Author

Ned Mumtaz has over 20 years of experience in the pharmaceutical industry. As the VP-Compliance, and Practice Director for Pharmaceutical Services at qordata, he is leading the transparency directive program in the US and EU.