Opioid Management

We keep up with CMS.

As clinically-appropriate prescribing and use of opioids increases, so do the risks for misuse, abuse, and fraud. CMS recognizes this fact, and encourages Health Plans to extend Medication Management services to their opioid-using population. To help you do this, CSS offers our Opioid Management solution.

We identify at-risk members.  

CSS’s Opioid Management solution focuses on members using high levels of opioids, and getting them from multiple sources. Within our software, we have developed an algorithm for identifying your members who are most at-risk for opioid misuse and abuse. Our algorithm seeks out members who are taking at least 100 mg morphine equivalent dose (MED), are getting prescriptions from at least three providers, and are filling prescriptions at at least three pharmacies.

We give you options.

Our Opioid Management solution offers two program possibilities: a provider-focused program or a provider and patient-focused program. A provider-focused program’s main goal is modifying prescribing behaviors by making clinically-appropriate recommendations when potential misuse or abuse is detected. In the event that the member’s opioid drug regimen is necessary, prescriber rationale is collected and documented. A provider and patient-focused program provides the additional service of support referrals for members at risk for abuse and addiction.

We meet your needs.

The Opioid Management solution can stand-alone, as a fully-functioning program, or operate as part of a larger MTM program—whether CSS is your primary MTM vendor or not.