Medicare Part D Proposes Limiting Opioids For Recipients
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Last week the Centers for Medicare & Medicaid Services (CMS) issued a proposal that suggests limitations on the number of opioids that Medicare recipients will be allowed to receive.
The proposed amendments, which would go into effect in 2019, include enacting tough “opioid safety edits” at pharmacies. Moreover, restricting how many opioids those using Medicare’s Part D prescription drug benefit can receive. The plan sets the level at 90 morphine milligram equivalent (MME) with a one-week supply cap.
CMS deputy administrator and director of the Center for Medicare, Demetrios Kouzoukas, as reported by MedPage, said that if the prescription were to exceed the limit, this would act as a trigger for conversation between the doctor, patient, and insurer about prudent opioid prescribing and use.
Moreover, for the patient to receive more than the set limit, it would have to be overridden by the patient’s insurer.
Another possible change would involve setting a supply limit for a first-time opioid prescription for acute pain with or without a daily dose maximum.
CMS is also proposing to enhance their overutilization monitoring system by detecting high-risk recipients who use drugs that can increase the risk of overdose if taken with opioids. These include benzodiazepines, gabapentin, and pregabalin.
“We are proposing important new actions to reduce seniors’ risk of being addicted to or overdoing it on opioids while still having access to important treatment options. We believe these actions will reduce the oversupply of opioids in our communities.”
Medicare recipients include adults over age 65, people with disabilities, and patients with end-stage renal disease.
Research has found that most people who are prescribed opioids do not become addicted. However, other research has revealed that 75% of all opioid abuse begins as drug diversion, such as when a person uses medication that is not prescribed to them.
~ G. Nathalee Serrels, M.A., Psychology