Administrator Medicare Part D Retrospective Opioid Overutilization Program Sample Clauses

Administrator Medicare Part D Retrospective Opioid Overutilization Program. The Administrator Medicare Part D Retrospective Opioid Overutilization Program consists of Administrator (in conjunction with necessary third parties) performing a retrospective review of Eligible Participants’ prescription claims and, if available and agreed to by the parties, medical data, to identify Eligible Participants filling multiple prescriptions written by different prescribers and dispensed at different pharmacies as it relates to opioid narcotic medications that exceed all medically-accepted norms of dosing. In the event Administrator identifies clinical concerns regarding an Eligible Participant’s drug regimen, Administrator will communicate its findings to the prescribers. Administrator will provide case management which will include the necessary outreaches to the prescriber, referral for any identified fraudulent activity, implementation of point-of-sale edits, and beneficiary and prescriber notifications. These programs may be subject to change based on CMS requirements.