New CMS Regulations Include Drug Management Program, Opioid Disposal

Forward-looking plans have options to prepare for January 2022 implementation
Woman gazing into a crowded medicine cabinet

As opioid misuse and deaths reach record highs, the Centers for Medicare and Medicaid Services (CMS) is preparing to implement new requirements in its Medication Therapy Management (MTM) program.

  • All at-risk beneficiaries (ARBs) under a Drug Management Program (DMP) will be targeted for MTM, even if they don’t meet other MTM targeting criteria.
  • Plans must provide all MTM enrollees with information about safely disposing prescription drugs that are controlled substances, including opioids.

These changes, which will take effect on January 1, 2022, are expected to reduce spending on prescription drugs, saving the federal government an estimated $75.4 million over 10 years.

How plans can ensure they are ready for these 2022 regulations

  • Educate qualified members about how to safely dispose of unneeded prescription drugs that are controlled substances.
  • Work on a process to identify and integrate at-risk beneficiaries into the MTM program, providing the level of services that traditionally qualified MTM members receive.
  • Establish appropriate monitoring and oversight to ensure the plan is in compliance with these new requirements.
See how our solutions can help
Express Scripts PBM Medication Therapy Management
Medication Therapy Management from Express Scripts takes the pressure off of plans, anticipating CMS changes and meeting all new needs. In addition, the program can identify at-risk beneficiaries more easily, allowing plans to take a more streamlined and hands-off approach to integrate these members into the MTM program.