CMS Proposes Opioid Prescribing Limits for Medicare Enrollees

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed regulations establishing new limits on pharmacies for filling opioid prescriptions for Medicare beneficiaries "to reduce seniors' risk of being addicted to or overdoing it on opioids while still having access to important treatment options," says the Center for Medicare's Demetrios Kouzoukas, as reported in MedPage Today . "We believe these actions will reduce the oversupply of opioids in our communities." The proposal mandates that Part D plans should implement "hard formulary levels" at pharmacies which would restrict the amount of opioids that beneficiaries could get. "These are triggers ... that can prompt conversations between physicians, beneficiaries, and plans about appropriate opioid use and prescribing," Kouzoukas says. "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 with a seven-day supply allowance. The regulations also would limit the number of pills in an initial prescription for acute pain, "possibly with or without a daily dose maximum," Kouzoukas notes. He says CMS is accepting comments on the proposals through March 5, and the agency also "expects sponsors to implement 'soft' safety edits" to flag a potential problem, although those could be overridden by the pharmacist. Kouzoukas also notes CMS "is ... enhancing our very successful opioid utilization monitoring system by adding flags for beneficiaries who use certain drugs in combination with prescription opioids. And we're considering a new measure on the concurrent use of opioids and benzodiazepines."