Medicare Cracks Down on Opiod Problem

Medicare has announced new guidelines for beneficiaries who receive high-dose opioids. Due to the rising deaths from opioids in America, the government and Medicare officials have decided to take action to fix the problem and reduce deaths. The overdose of opioids has been a rising cause of deaths in the USA, killing over 60, 000 people in 2016. The new guideline was designed to crack down on doctors over prescribing opioids, as well as to make sure beneficiaries are not abusing their medications.

Because some Medicare beneficiaries overuse their prescription opiods, CMS has created new guidelines,
Because some Medicare beneficiaries overuse their prescription opiods, CMS has created new guidelines,

The Centers for Disease Control and Prevention, CDC, estimated that almost 100 Americans die every day due to an opioid overdose. President Trump decided that it was time to take action and battle the opioid addiction, starting with how much and often they are being prescribed.

Of the estimated 50 million Medicare beneficiaries in America, one in three are prescribed opioids or painkillers. Medicare wants to take part in the opioid addiction problem by putting restrictions/guidelines on the opiods that are given to their beneficiaries.

The New Guideline

The new plan has been finalized in April that will make it harder for Medicare patients to receive high doses of painkillers. The Centers for Medicare and Medicaid Services, CMS, will require all new opioid prescriptions for short term acute pain limited to no more than a weeks worth of supply.

In 2019, morphine prescriptions will be limited to 90mg at a weeks time. If a doctor or patient tried to receive more

If a Medicare patient is prescribed more than the set amount of the guidelines, the pharmasict must talk to the doctor.
If a Medicare patient is prescribed more than the set amount of the guidelines, the pharmasict must talk to the doctor. If they agree with the answer, they will allow the patient to get the prescription.

than this set limit, then it would trigger a “hard safety edit” in which the pharmacist must talk to the prescribing doctor about the dosage. If the pharmacist is happy with the answer then they can override and fill the prescription, and if not then they do not have to fill it and Medicare will not pay for it. If denied, the doctor will have to appeal the decision and show why it is medically necessary for the patient to have the high doses in order for Medicare to reconsider. These guidelines will not apply to those who are suffering from cancer or in hospice.

The new limit is a hopeful tactic to catch doctors who overprescribe, and keep an eye on patients who take more opiates than necessary from different doctors. This way Medicare and the government can try to reduce overprescription that will lead to overdose or patients selling their prescriptions.

Demetrios Kouzoukas, CMS deputy administrator and director of the Center for Medicare, told MedPage Today that if the prescription exceeds the limit, that would act as a “trigger” for a conversation between the physician, patient and insurer about “appropriate opioid use and prescribing.” To get more than the proposed limit, the limit would have to be overridden by the patient’s insurance plan.

The CMS estimates that about 1.6 million Medicare beneficiaries have prescriptions above the set 90mg level. The real battle will be determining that the correct patients that need the dosage required will receive it, while halting the access of addictive drugs to patients who do not need it.

Leave a Reply

Your email address will not be published.

Let's Chat