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Opioid Prescription Limits

Opioid prescription limitations

More than 17% of Americans had at least one opioid prescription filled in 2017 and it’s estimated that about 25% of them misused the medication. The opioid epidemic is impacting millions of lives every year, so preventive measures are being put in place on all fronts to reduce the impact. Medicare has joined the fight and created 3 new provisions that help identify and reduce the risk of older adults abusing opioids.

  • Opioid prescription limitations & checks for all Part D enrollees – requires Part D sponsors to limit initial opioid prescription fills for the treatment of acute pain to no more than a 7-day supply. Part D sponsors must also implement a flag at 90 MME (morphine milligram equivalent) per day, so when a beneficiary’s reaches that limit the pharmacist must consult with the prescriber, document the discussion, and if the prescriber confirms intent, use an override code that specifically states that the prescriber has been consulted.
  • Limitations on Part D enrollees considered “at risk” for prescription drug abuse – Part D plan sponsors must establish a drug management program for beneficiaries deemed at risk for prescription drug abuse. “At-risk beneficiaries” are identified as those that take a specific dosage of opioids and/or obtain them from multiple prescribers and multiple pharmacies. Plans may utilize a “lock in” provision to limit at-risk beneficiaries’ access to coverage of frequently abused drugs to a selected prescriber(s) and/pharmacy(ies) after case management with the prescribers and beneficiaries.

Heres the Link to Medicare.gov to Explain this New Medicare Policy..

Medicare Part D and Opioids