How will my Medicare Part D prescription drug plan actively fight the opioid epidemic?

Starting back in 2019, your Medicare Part D plan (MAPD or PDP) implemented a drug management program (or drug utilization management) to monitor and limit "at-risk" Medicare beneficiaries’ access to frequently abused drugs (such as opioids and benzodiazepines).

According to the policy, Medicare Part D plans will be permitted to have a “lock-in” feature “to limit an at-risk beneficiary’s access to frequently abused drugs to a selected prescriber(s) and/or pharmacy(ies).”

CMS also limits

“The availability of the special enrollment period (SEP) for dually or other low income subsidy (LIS) eligible beneficiaries who are identified as at-risk or potentially at-risk for prescription drug abuse under such drug management programs. At-risk determinations, which include prescriber and pharmacy lock-in, will be subject to the existing beneficiary appeals process.” [emphasis added]

Question: What drugs are considered prescription opioids?

According to the National Institute on Drug Abuse:

"Prescription opioid medications include:

hydrocodone (e.g., Vicodin®),

oxycodone (e.g., OxyContin®, Percocet®),

oxymorphone (e.g., Opana®),

morphine (e.g., Kadian®, Avinza®),

codeine,

fentanyl, and others.

Hydrocodone products are the most commonly prescribed in the United States for a variety of indications, including dental- and injury-related pain.

Oxycodone and oxymorphone are also prescribed for moderate to severe pain relief.

Morphine is often used before and after surgical procedures to alleviate severe pain, and codeine is typically prescribed for milder pain.

In addition to their pain-relieving properties, some of these drugs—codeine and diphenoxylate (Lomotil®), for example—are used to relieve coughs and severe diarrhea."

This opioid policy was one of the highlights from the 2019 final Call Letter and a 1,156 page Medicare Part D (unpublished) Final Rule released on April 02, 2018 by the Centers for Medicare and Medicaid Services (CMS) and includes steps to fight the opioid epidemic that has been declared a Public Health Emergency by the Secretary Health and Human Services (HHS).

For further information about prescription opioids, please see: www.drugabuse.gov/ publications/ misuse-prescription-drugs/ what-classes-prescription -drugs-are-commonly-misused

For additional information on the government's response to the opioid epidemic please see:

The CMS page: "Reducing Opioid Misuse"
www.cms.gov/about-cms/story-page/reducing-opioid-misuse.html

Improved Opioid Safety Alerts, 2019 Medicare Parts C&D Final Call Letter. www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html

Question: What Progress has been made?

CMS coverage policies now ensure some form of medication-assisted treatment (MAT) across all CMS programs. Starting January 1, 2020, for the first time, Medicare covers methadone for MAT and related services furnished by opioid treatment programs (OTPs). On January 21, 2020, Medicare coverage expanded to include acupuncture for certain beneficiaries with chronic low back pain.
While implementation of drug management programs (DMPs) by Part D sponsors has been optional since 2019, 87% have already adopted them to address opioid overutilization among their enrollees.8 lmplementation of DMPs by Part D sponsors will be mandatory in CY 2022. In 2020, for the first time, all plans have at least one naloxone product on a non-branded tier.
Due to policies promoting safer use, the number of Medicare beneficiaries receiving higher doses of opioids (≥ 90 morphine milligram equivalents (MME) for at least one day) declined by 45% between 2016 and 2019.

(source: www.cms.gov/About-CMS/ Agency-Information/ Emergency/Downloads/ Opioid-epidemic-roadmap.pdf)