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Texas HHS Vendor Drug Program (VDP) will implement a uniform opioid policy for Medicaid (both fee-for-service and managed care) and CHIP to encourage appropriate use and reduce opioid over-prescribing effective 9/1/20. #DPPRtx…
1) Recently, HHS Federal Register “more or less” in very “ambiguous language” advised that the Feds were passing the buck to the States, and that States were only “liable” to adhere to “minimum Federal standards” for participation in Medicaid (qualify
2) for eligibility for Federal funding for each State Medicaid program) in reference to opioid policy, and the States were more or less “free to create” more “stringent standards” at their pleasure, hence there were “Medicaid Drug Utilization Review” meetings held in Texas
3) open to public), and this is the outcome. I suggest that we will see more like this in every state. This is how they “bypassed” Oregon.
1). Original Notice: Texas Drug Utilization Review Board will meet online using Microsoft Teams on July 24, 2020.
Registration is required for all people attending through the virtual attendance registration. In addition, people providing public or written testimony must complete
2) the testimony registration.
All registrations forms and special instructions for public testimony will be available soon from the Vendor Drug Program website.
Contact for more information.
1) Links expanding on this topic. CMS regulations at 42 CFR 456.703(d) require that the state assess drug use information against predetermined standards developed directly by the state or obtained from another source as provided under 42 CFR 456.703(e).
2) In administering their DUR programs, (attention) states have flexibility to develop or select standards that may best fit their programs & patient populations. This proposed rule amends this section of the regulation to implement new opioid related DUR standards that are
3) are required of states under section 1004 of the SUPPORT for Patients and Communities Act, as well as additional opioid-related DUR standards that CMS would propose under the authority of section 1927 of the Act. These changes reflect CMS’ continued efforts to reduce
4) prescription-related fraud, abuse and misuse and assure that opioid prescriptions are appropriate, medically necessary, and not likely to result in adverse medical results.
5) Additionally, we are soliciting comments on other opioid-related DUR standards that CMS could propose to adopt through rulemaking in the future.”
(DUR = Drug Utilization Review)…
6) “this creates minimum standards in state Medicaid Drug Utilization Review (DUR) programs designed to reduce opioid-related fraud, misuse and abuse..”
7). H. Changes Related to the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act/ Pg 17-18 Notice how the language is using old stats and stating that opioid deaths are from RX opioids-
8) failing to mention those OD’s were not prescribed but were from diverted RX.
This is a rush to impact Medicaid patient’s access to opioid therapy. They sneakily attached this to rule making to value based purchasing.
Shame on HHS!…
9) 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…
10) CMS Issues Proposed Rule to Empower Commercial Plans and States to Negotiate Payment for Innovative New Therapies Based on Patient Outcomes
Jun 17, 2020…
11) 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 (CMS 2482-P) Fact Sheet…
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