Part D Drug Management Program Criteria Check (OMS)
Whether a member meets the Part D drug management program criteria.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Exemption
- None of these
- Highest average daily MME in the most recent 6 months, buprenorphine left out
- 120 MME
- Opioid prescribers in the most recent 6 months
- 3
- Opioid dispensing pharmacies in the most recent 6 months
- 3
- A Part D opioid fill, not for opioid use disorder, in the most recent 6 months
- Yes
- An opioid-related overdose claim in the most recent 12 months
- No
Result: Meets minimum criterion 1.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Exemption
- Highest average daily MME in the most recent 6 months, buprenorphine left out
- Opioid prescribers in the most recent 6 months
- Opioid dispensing pharmacies in the most recent 6 months
- A Part D opioid fill, not for opioid use disorder, in the most recent 6 months
- An opioid-related overdose claim in the most recent 12 months
How this is calculated
Citation
CMS. Part D Drug Management Programs guidance, Rev. 7, December 16, 2025, sections 4.1 and 4.2: minimum and supplemental overutilization monitoring criteria. 42 CFR 423.100: exempted beneficiary. 42 CFR 423.153(f)(16): clinical guidelines. Read the sources: CMS guidance, Rev. 7 ↗, 42 CFR 423.100 ↗, 42 CFR 423.153 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.