New Medicare Prescription Drug Policies Address Opioid Epidemic > Hospital Association of Pennsylvania


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New Medicare Prescription Drug Policies Address Opioid Epidemic

April 02, 2019

The Centers for Medicare & Medicaid Services (CMS) has introduced new safety policies for the use of opioid medications covered by the Medicare Part D prescription drug benefit. The goal is to reduce opioid misuse while preserving medically necessary access to these medications. 

The new policies include safety checks by pharmacists and Medicare drug plans as well as provisions that allow physicians to request exceptions.

At the heart of the policies is improved safety checks for Part D beneficiaries who are filling their first opioid prescriptions or who are receiving high doses of prescription opioids. Medicare drug plans may alert pharmacists filling such prescriptions if they:

  • Call for amounts of opioids that may be unsafe because they exceed guidelines
  • Do not follow the clinical best practice of limiting to seven days supplies of opioids prescribed for acute pain if beneficiaries haven’t taken opioids recently
  • Involve the potentially dangerous use of opioids and benzodiazepines at the same time

If a prescription can’t be filled as written, beneficiaries will be advised that they or their doctors can contact drug plans to determine whether the prescription will be covered. Exceptions can also be requested beforehand, so beneficiaries know in advance whether prescriptions are covered.

The new safety policies do not apply to:

  • Residents of long-term care facilities
  • Patients in hospice, palliative, or end-of-life care
  • Patients being treated for active cancer-related pain 

Pennsylvania has been deeply impacted by the opioid crisis. The U.S. Drug Enforcement Administration reports that 5,456 Pennsylvanians died from drug-related overdoses during 2017—a rate nearly double that of the U.S.

HAP appreciates CMS efforts to strengthen the safety of prescription opioid use by beneficiaries covered by Medicare Part D. Pennsylvania’s hospital community has been working with federal, state, and local governments to address the opioid crisis head on.

Hospitals are setting guidelines to limit the quantity and duration of opioid prescriptions, implementing emergency department warm hand-off protocol, utilizing Pennsylvania’s Prescription Drug Monitoring Database, installing drug takeback locations, and engaging in community and patient education about the dangers of opioids and options for alternative pain management.

For more information about the CMS policies or Pennsylvania hospitals’ work to combat the opioid epidemic, please contact Jennifer Jordan, HAP’s vice president, regulatory advocacy.

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