Medicare pharmacy and prescriber home starts January 2019
- Cumulative Morphine Milligram Equivalent (MME) > 90mg per day
- Opioid prescribers > than three and opioid dispensing pharmacies > than three
- Or Opioid prescribers > than five regardless the number of pharmacies
- Cancer, LTC and Hospice are exempt
- Beneficiaries will have the choice of which pharmacy or prescriber to select as their home.
- Plan sponsors will request agreement from the provider selected as the home.
- At this time, only opioid and benzodiazepine medications will be delegated to a home pharmacy or prescriber.
- Both beneficiaries and providers will receive letters to explain what is happening and how it will happen.
- Beneficiaries retain the right to request a coverage determination and may choose to change their Home pharmacy or prescriber at any time.
October 2018 Anthem Provider Newsletter - CO