Wilmington, MA – Following new guidance from the Centers for Medicare and Medicaid Services, Ametros recently expanded its Drug Monitoring Program to enhance tracking of the use of controlled substances on Medicare Set-Asides it professionally administers. Ametros provides pharmacy discounts and clinical management services as part of its CareGuard program for its members, who are patients with medical settlements resulting from personal injuries.
The recently updated Version 3.0 of CMS’ Workers’ Compensation Medicare Set Aside Arrangement (WCMSA) Reference Guide states:
- “CMS highly recommends professional administration where a claimant is taking controlled substances that CMS determines are ‘frequently abused drugs’ according to CMS’ Part D Drug Utilization Review (DUR) policy. That policy and supporting information are available here.” (See Sec. 17.1.)
- CMS has identified opioids and benzodiazepines as frequently abused drugs.
- “CMS expects that WCMSA funds be competently administered in accordance with all Medicare coverage guidelines, including but not limited to CMS’ Part D Drug Utilization Review (DUR) policy. All professional administration programs should institute Drug Management Programs (DMPs) (as described more fully here) for claimants at risk for abuse or misuse of “frequently abused drugs.” (See Sec. 17.3.)
“Medicare has shown concern about the opioid crisis and is trying to find ways to keep patients safe. This new guidance is a natural extension of their strategy and it’s encouraging that Ametros is doing its part to protect the well-being of these patients,” commented Tom Barker, Partner at Foley Hoag, former General Counsel of the U.S. Department of Health and Human Services (HHS) and General Counsel of the Centers for Medicare & Medicaid Services (CMS).
Ametros expanded its DMP protocol, incorporating these new recommendations so the program now:
- Alerts pharmacists when a CareGuard member is receiving both opioids and benzodiazepines. This is especially important when members have multiple prescribers and/or pharmacies.
- Periodically monitors CareGuard members who meet CMS recommended guidelines for high opioid usage. In these cases, there will be coordinated communication with the member and their prescribers.
- Alerts pharmacists to high opioid use, including multiple opioids.
“We recognize that many of our members have been receiving long-term care and oversight of their treatment prior to their settlement,” says Ametros’ Vice President of Pharmacy and Managed Care Chris Lagnese. “Our goal is to facilitate their continued care while applying measures to guard their safety and assist in the coordination with their providers.”