Part D Opioid Safety Edits: Which One Fires? (90 MME, 7-Day, 200 MME)
Which Part D opioid point-of-sale safety edit would fire, and the way past it.
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
- Cumulative daily MME across active opioid prescriptions
- 120 MME
- Days supply of the new opioid prescription
- 30 days
- An opioid fill within the plan lookback window
- Yes
- The plan uses the optional hard edit at 200 MME
- No
- Also on a benzodiazepine
- No
- More than one long-acting opioid
- No
Result: 1 edit would fire.
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Exemption
- Cumulative daily MME across active opioid prescriptions
- Days supply of the new opioid prescription
- An opioid fill within the plan lookback window
- The plan uses the optional hard edit at 200 MME
- Also on a benzodiazepine
- More than one long-acting opioid
- Prescriber count the plan attaches to its MME edits, if any
The other 3 fields
- Pharmacy count the plan attaches to its MME edits, if any
- Number of opioid prescribers the member has
- Number of opioid pharmacies the member has
How this is calculated
Citation
CMS. Contract Year 2027 Medicare Part D Opioid Safety Edits: Submission Instructions, Recommendations, and Reminders. July 2, 2026. CMS. Frequently Asked Questions about Formulary-Level Opioid Point-of-Sale Safety Edits, as of July 5, 2024. Read the sources: CMS memo, contract year 2027 ↗, CMS FAQ, July 5, 2024 ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.