CMS proposes a 7-day limit on initial opioid prescriptions

Hydrocodone opioid pills
CMS is proposing a seven-day limit on initial opioid prescriptions for Medicare Part D patients. (Image: Getty/smartstock)

In a move that is sure to be controversial among doctors, the Centers for Medicare & Medicaid Services is proposing that physicians limit initial prescriptions for opioid painkillers to just seven days.

The proposal, which would take effect in 2019, was made to help reverse the country’s opioid epidemic, which has been blamed in part on physicians overprescribing painkillers. 

RELATED: Express Scripts to place new limits on opioid prescriptions, drawing criticism from AMA

Innovation Awards

Submit your nominations for the FierceHealthcare Innovation Awards

The FierceHealthcare Innovation Awards showcases outstanding innovation that is driving improvements and transforming the industry. Our expert panel of judges will determine which companies demonstrate innovative solutions that have the greatest potential to save money, engage patients, or revolutionize the industry. Deadline for submissions is this Friday, October 18th.

The proposal to implement a supply limit for initial opioid prescriptions for acute pain for Medicare Part D patients was included in a CMS fact sheet. CMS is seeking comments on the proposal through March 5, before it finalizes changes that it will publish by April 2.

The plan to limit a patient’s supply of opioids was among a number of changes CMS proposes to its Medicare Part D opioid overutilization policy that focuses on patient safety. “Given the urgency and scope of the continuing national prescription opioid epidemic, we will propose new strategies to more effectively address this issue for patients in Part D,” the agency said.

In a 2018 Draft Call Letter, CMS also proposed that Medicare Part D prescription drug plans monitor patients who take medications, such as gabapentin and pregabalin, that can lead to opioid-related adverse events. CMS’ overutilization monitoring system already flags concurrent benzodiazepine use by plan enrollees.

Major insurers and other companies have already taken moves to limit opioid prescribing. Express Scripts, the country’s largest pharmacy benefit manager, began a program last September to limit the number and strength of opioid medications that doctors can prescribe to first-time users. The move met with resistance by the American Medical Association, which said doctors and patients should make decisions about prescriptions and treatment plans.

Anthem, one of the country’s largest insurers, said it was able to reduce filled opioid prescriptions by 30%. It took steps in 2016, such as limiting coverage for newly prescribed short-acting opioids to seven days for all individual, employer-sponsored and Medicaid plan members—with the exception of those receiving palliative care or who have sickle cell anemia or cancer.

However, as doctors limit opioid prescriptions, pain patients say they are being abandoned by the medical system, and face pain and drug withdrawal.  Fearing possible criminal charges and even the loss of their medical licenses, doctors have been prescribing fewer opioids.

Suggested Articles

As the public debate on health reform rolls on, a new report analyzes how these different approaches could impact insurers' bottom lines.

A House panel is going to consider several changes to Nancy Pelosi's drug prices plan, including stiff penalties for not being transparent.

Molina aims to bolster its Medicaid business by acquiring certain assets from New York-based YourCare for $40 million.