The Obama administration has outlined a strategy for reducing illicit drug use that includes a proposed drug utilization review and restriction (DURR) program for Medicare to curb opioid overuse.

In its recently released National Drug Control Strategy, the White House Office of Drug Control Policy highlighted the success of DURR programs. Many state Medicaid programs and private insurers use DURR programs to restrict a patient’s points of access to opioid drugs if they believe the patient has received these drugs from too many sources. Medicare does not have this ability through its Part D prescription coverage, but does have an opioid overutilization policy that allows Medicare to contact physicians if a patient appears at risk of opioid drug overuse.

The administration’s fiscal year 2016 budget includes a proposal to allow the Centers for Medicare & Medicaid Services (CMS) to establish a DURR program to complement the opioid overutilization policy, with the aim of restricting coverage to certain providers and pharmacies for patients at risk of abusing opioid prescriptions.

Administrative agencies, including the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC), are working on a companion strategy to target the nation’s opioid epidemic that would mirror the National Drug Control Strategy. The CDC is expected to release prescribing guidelines aimed at providers in early 2016.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.