New Medicare Part D Policies Aim to Tackle Opioid Abuse

New Medicare Part D Policies Aim to Tackle Opioid Abuse

In continuing efforts to address the opioid epidemic, the Centers for Medicare and Medicaid Services (CMS) has introduced new Medicare Part D patient policies designed to curtail abuse while still preserving access for patients in need of pain management, according to HealthPayerIntelligence.

The policies include:

  • Improved pharmacy safety alerts for Part D beneficiaries
  • Alerts for pharmacies to review certain opioid prescriptions before filling

The policies seek to address the role of physician-prescribed opioid medications in the current opioid crisis, according to Kimberly Brandt, principal deputy administrator for operations at CMS. “As Medicare pays for a significant amount of prescription opioids, we strive to ensure appropriate stewardship of these medications that can provide a medical benefit but also carry a risk for our beneficiaries,” wrote Brandt in a blog post.

According to Brandt, the safety alerts may cover situations such as:

  • Possible unsafe amounts of opioids
  • First-time fills for opioid prescriptions
  • Use of opioids and benzodiazepines at the same time

These alerts address a range of issues that can occur during prescription opioid use. The first-time fill alert, for example, is based on “medical best practices that show that the risk of developing an opioid use disorder increases after 7 days of use.” Part D beneficiaries may be limited to a seven-day supply in cases of acute pain treatment.

Brandt notes that the policies are “deliberately tailored to address distinct populations of Medicare Part D prescription opioid users.” Beneficiaries that are residents of long-term care facilities; receiving hospice, palliative, or end-of-life care; and receiving treatment for active cancer-related pain are not impacted by these new safety alert interventions.

For more information on the new policies, click here.


Sarah Sheber is assistant editor/web editor at Journal of AHIMA.