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1,156 page Medicare Part D (unpublished) Final Rule released on April 02, 2018 by the Centers for Medicare and Medicaid Services (CMS) and includes steps to fight the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