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Finalized CMS Policy Increases Access to Medication-Assisted Treatment

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Michael Petruzzelli

, National Council for Behavioral Health

Finalized CMS Policy Increases Access to Medication-Assisted Treatment

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New policies from the Centers for Medicare and Medicaid Services (CMS) will require Medicare Part D formularies to allow access to medication-assisted treatment for substance use disorders such as buprenorphine, naloxone and naltrexone. The policy is a response to President Obama’s October call to action, having the federal government identify barriers to treatment for opioid use disorders. CMS said it will continue to review utilization management and formulary tiering to ensure access throughout Medicare Part D.

In addition to the new medication-assisted treatment policies, CMS announced the following:

  • Insurers are now encouraged to begin notifying beneficiaries of any midyear changes to formularies, including newly approved brand or generic medications;
  • CMS will make available online its new dashboard for Medicare drug spending by 2017; and
  • Insurers will be required to implement policies by 2018 that prohibit claims for prescription opioids at pharmacies for consumers who have met a certain threshold for total amount of prescriptions filled.

The National Council will continue to monitor the Department of Health and Human Services and its agencies as they continue to publish new guidance, regulations and proposed rules related to the President’s opioid epidemic initiative.

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