After their first semi-annual review, Ametros announced today another improvement to its CareGuard professional administration service that helps its members (patients who have received an injury settlement) remain even safer after settlement. For years, Ametros’ safety protocols have included prompts and alerts to pharmacists prior to dispensing to notify them of validation of refill timing and potential drug-to-drug interactions across all pharmacies. Now, with new guidance released from the Centers for Medicare & Medicaid Services (CMS or Medicare), Ametros is evolving its safety measures for all Medicare Set Aside (MSA) accounts to make sure the health and well-being of its members continue to be the top priority.
On October 30, 2019, Medicare announced in Version 3.0 of the Workers’ Compensation Medicare Set Aside Arrangement (WCMSA) Reference Guide, the following:
- “CMS highly recommends professional administration where a claimant is taking controlled substances that CMS determines are ‘frequently abused drugs’ according to CMS’ Part D Drug Utilization Review (DUR) policy. That policy and supporting information are available here.” (See Sec. 17.1.)
- CMS has identified opioids and benzodiazepines as frequently abused drugs. See page 2 of: A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019
- “CMS expects that WCMSA funds be competently administered in accordance with all Medicare coverage guidelines, including but not limited to CMS’ Part D Drug Utilization Review (DUR) policy. All professional administration programs should institute Drug Management Programs (DMPs) (as described more fully here) for claimants at risk for abuse or misuse of “frequently abused drugs.” (See Sec. 17.3.)
Starting in January 2020, Ametros began reviewing all prescriptions from October 2019 forward as part of a new expanded protocol and Drug Monitoring Program (DMP) to include the CMS recommended guidelines regarding opioid medications. Ametros is leveraging its in-house pharmacy technicians as well as its pharmacy and provider resources to interact more frequently with members and prescribers to facilitate alerts. These new prompts build on the existing pharmacy and clinical support services that Ametros already provides as the leader in the industry.
Chris Lagnese
Vice President of Pharmacy and Managed Care for Ametros
“Our Members’ safety and compliance with CMS are first and foremost. We recognize that our members have often been receiving long-term care and oversight of their treatment prior to their settlement,” says Ametros’ Vice President of Pharmacy and Managed Care, and pharmacist, Chris Lagnese. “Ametros’ goal is to facilitate their continued care while applying measures to guard their safety and assist in the coordination with their providers.”
While MSAs can routinely be funded with frequently abused drugs, CMS has now recognized that the most effective way to keep injured parties safe well after the settlement is through professional administration. In accordance with CMS’ new recommended guidelines, CareGuard members’ healthcare professionals are also meant to be actively engaged to assist them in providing prudent care decisions.
Ametros’ enhanced monitoring and support as recommended by CMS includes:
- Alerts to the pharmacist when a CareGuard member is receiving both opioid and benzodiazepines. This is especially important as sometimes different pharmacy chains may otherwise be unaware.
- Periodic monitoring of CareGuard members who meet CMS recommended guidelines for high opioid usage across multiple prescribers and/or pharmacies. In these cases, there will be coordinated communication with the member and their prescribers.
- Alerts to the pharmacist for high opioid usage, including multiple opioids
Thomas Barker
Former General Counsel for the Centers for Medicare & Medicaid Services (CMS) and HHS & Healthcare and Regualtory Partner
“Medicare has shown concern about the opioid crisis and is trying to find ways to keep patients safe. This new guidance is a natural extension of their strategy and it’s encouraging that Ametros is able to do their part to protect the well-being of these patients,” commented Tom Barker, Partner at Foley Hoag, former General Counsel of the U.S. Department of Health and Human Services (HHS) and General Counsel of the Centers for Medicare & Medicaid Services (CMS) and a member of Ametros’ Regulatory Council.
Colin Zick
Healthcare, Privacy & Data Security Partner
“It’s important that this sensitive information be gathered, kept secure and used appropriately,” says Colin Zick, Partner at Foley Hoag and also an Ametros Regulatory Council Member. “Having a reputable professional administrator like Ametros involved helps ensure this information is used to its full potential for better outcomes.”
Learn More About Ametros' Regulatory Council
Read the full press release: www.businesswire.com
