Medicare open enrollment begins on October 15, ends December 7

Formulary-level hard cumulative MED opioid safety edits not required

It’s that time of year again!

In September, CMS announced that the average basic premium for a Medicare prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the average basic premium of $34.70 in 2017. The Medicare prescription drug plan average basic premium is projected to decline for the first time since 2012.

CMS addressed a number of key issues raised by pharmacists in the annual Call Letter:

-Removing the requirement for Part D plans to implement formulary-level hard cumulative MED opioid safety edits for 2018. CMS continues to expect plans to implement, at a minimum, a soft opioid safety edit, where the threshold must be set at levels greater than 90 mg MED. If plans still choose to implement a hard opioid safety edit, the threshold will be set at 200 mg MED or more. CMS will continue to monitor 2017 experience with these edits to determine future requirements.

-Increasing the use of Pharmacy Quality Alliance measures for CMS’s and plans’ internal use of display measures. For example, measures listed on CMS’s web site for Medicare beneficiaries that do not affect plan payments, and star ratings measures that directly affect plan payments.

-Acknowledging pharmacy organizations’ recommendation to further emphasize pharmacist involvement in the enhanced medication therapy management (MTM) model. Unfortunately, CMS is increasing the current MTM cost threshold to $3,967, which will continue to exclude many beneficiaries with complex conditions, but smaller drug spends, potentially through the use of generic medications, who could benefit from MTM services.

-Recognizing and sharing with the National Committee for Quality Assurance pharmacy organizations’ support for telehealth and remote access technologies in future star ratings measures.

APhA will provide an expanded update on what pharmacists and their patients should know about Medicare prescription drug plans for 2018. For this article and more, please visit for the upcoming December 2017 issue of Pharmacy Today.