This article first appeared February 1, 2018 on MedPage Today.
Joyce Frieden, News Editor, MedPage Today
Pharmacies would have new limits on filling opioid prescriptions for Medicare beneficiaries under regulations proposed Thursday by the Centers for Medicare & Medicaid Services (CMS).
“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,” said Demetrios Kouzoukas, CMS deputy administrator and director of the Center for Medicare, on a phone call with reporters. “We believe these actions will reduce the oversupply of opioids in our communities.”
Under the proposal, Part D plans would implement so-called “hard formulary levels” at pharmacies which would restrict the amount of opioids that beneficiaries could receive. “These are triggers … [that] can prompt conversations between physicians, patients, and plans about appropriate opioid use and prescribing,” Kouzoukas said. “The trigger can only be overridden by the plan sponsor after efforts to consult with the prescribing physician.” The safety level would be a 90 morphine-mg equivalent (MME) with a 7-day supply allowance.
The proposal also would limit the number of pills in an initial prescription for acute pain, “possibly with or without a daily dose maximum,” he said, adding that CMS is accepting comments on the proposals through March 5. In addition, CMS “expects sponsors to implement ‘soft’ safety edits” to flag a potential problem, although those could be overridden by the pharmacist.
CMS “is also enhancing [our] very successful opioid utilization monitoring system by adding flags for beneficiaries who use certain drugs in combination with prescription opioids,” said Kouzoukas. “And we’re considering a new measure on the concurrent use of opioids and benzodiazepines. We believe these measures are important to … safeguard the health and safety of our nation’s seniors.”
These actions are part of the agency’s effort “to end the scourge of the opioid epidemic” in response to a call to do so by President Trump, he said. CMS’s opioid utilization monitoring system “is already successful in reducing the risk of overprescribing of opioids in the Part D program.” The agency made other proposals last November, including one allowing plans to limit beneficiaries’ access to opioids by having them go through only a selected prescriber and selected pharmacies, Kouzoukas said.
CMS also announced several other proposals in its Medicare Advantage call letter Thursday, including a new star rating for statin use among patients with diabetes or cardiovascular disease, and the inclusion of certain additional supplemental health benefits for Medicare Advantage enrollees if the benefits would compensate for physical impairments or reduce emergency department utilization.