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Highmark Begins Using CMS Opioid Safety Edits and CARA Provisions

One of Highmark’s top priorities is promoting the safe, effective use of opioid drugs among our members while preventing the development of opioid use disorder.

That is why, effective Jan. 1, 2019, Highmark began using Centers for Medicare & Medicaid Services (CMS) opioid safety edits and provisions of the Comprehensive Addiction and Recovery Act (CARA) .

In certain circumstances, pharmacies can resolve some safety edits. Therefore, the Highmark member’s pharmacy may contact you for more information before they fill prescriptions for opioid medications. Questions may include potential drug interactions, duplication of medications, or potentially incorrect dosages.

CARA allows Medicare Part D plans to establish drug management programs that will work with you to decide on the safest dose for the patient. Medicare Part D plans may limit at-risk beneficiaries’ access to coverage of controlled substances that are considered to be frequently abused drugs (FADs). Drugs in this category target opioids, along with benzodiazepines, benzodiazepines plus carisoprodol, and gabapentinoids.

For more information

To learn more, see the NaviNet® Plan Central message posted Dec. 21, 2018, for professional providers and titled “Highmark Implementing CMS Opioid Safety Edits and CARA Provisions Effective Jan. 1, 2019.”

You also can consult these resources:

We thank you for your vigilance in ensuring our members’ safety and well-being when considering the use of opioids.