Important Cancer Exemption in Proposal to Reduce Prescription Drug Misuse in Medicaid

August 3, 2020

The Association for Clinical Oncology (ASCO) submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to the Medicaid Program; Establishing Minimum Standards in Medicaid State Drug Utilization Review (DUR) and Supporting Value-Based Purchasing (VBP) for Drugs Covered in Medicaid, Revising Medicaid Drug Rebate and Third Party Liability (TPL) Requirements proposed rule. The proposal—which aims to reduce prescription-related fraud, misuse, and abuse—contains an important exemption for beneficiaries undergoing cancer treatment from additional opioid DUR requirements.

Proposed DUR requirements, which will not apply to Medicaid beneficiaries with cancer, include:

  • Limits on days’ supply for opioid naïve beneficiaries
  • Opioid quantity limits with dose optimization, which is a method to consolidate the quantity of medication dispensed to the smallest amount required to achieve the desired daily dose and regimen
  • Early fill limitations
  • Maximum daily morphine milligram equivalent limits

ASCO thanks CMS for the exemption, which will help patients with cancer—many of whom are immune-compromised and sheltering at home during the COVID-19 pandemic—avoid more frequent trips to their physician’s office or a pharmacy. ASCO also encourages the agency to continue maintaining such flexibility in program changes for special populations, as recognizing the needs of patients with cancer is especially important during this time of uncertainty.

Read the full comment letter.

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