Doctors Push Back Against Newly Proposed Opioid Rules For Medicare

By Keri Blakinger 03/12/18
One of the proposed policies would broadly deny coverage under Part D to first-time opioid users for prescriptions that exceed a 7-day supply.
Doctor saying no and wagging finger

Doctors are pushing back against newly proposed rules to curb prescription opioid use among Medicare recipients. 

As part of a response to the growing opioid overdose epidemic, the Centers for Medicare and Medicaid Services (CMS) last month put out a paper outlining two newly proposed policies. If adopted, they could take effect as soon as 2019. 

But medical professionals are objecting to the “knee-jerk” responses that could accelerate “a chaotic pattern of churn, abandonment and medical harm to patients,” according to Gizmodo

One of the proposed policies would limit patients to the equivalent of around 90 milligrams of morphine (MME) per day, according to reports. If the cumulative amount of opioids prescribed exceeds that limit, then the insurer would automatically deny coverage.

Patients with cancer, identified as terminally ill or with other pre-existing approvals would potentially qualify for an appeal from their doctor. 

Another policy would broadly deny coverage under Medicare Part D to first-time opioid users for prescriptions that exceed a 7-day supply—regardless of their diagnosis. 

Currently, there are some restrictions already in place for Medicare patients. Anyone filling prescriptions that total more than 90 milligrams of morphine equivalents per day can be denied at the pharmacy, depending on the pharmacist’s judgement. But they aren’t automatically denied unless their drugs total more than 200 MMEs. 

The CMS estimated that the new guidelines could impact up to 1.6 million people who are on Medicare and got more than 90 MME at least once in 2016, without a qualified exception. 

The new rules would be geared toward helping providers “do more to address chronic, high prescription opioid overuse,” according to CMS. 

But on March 5, a group of more than 150 physicians submitted a letter arguing otherwise. 

“While a strong case can be made for consensual, supported opioid dose reductions for voluntary patients, no data support nonconsensual/forcible dose reductions or curtailment in otherwise stable patients that have become common as prescribers react to regulations, mandates, insurers and fear for professional security,” the letter said.

Leo Beletsky, an opioid policy researcher at Northeastern University, agreed, though he was not one of the letter’s signatories. 

“There is little reason to believe these policies will drive down overdose risk—they have never been tested with that metric in mind,” he told Gizmodo. “There are, however, highly foreseeable collateral risks from these policies, including continuing the process of forcing patients to the black market.”

The newly proposed rules are expected to be finalized in early April.

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Keri Blakinger is a former drug user and current reporter living in Texas. She covers breaking news for the Houston Chronicle and previously worked for the New York Daily News and the Ithaca Times. She has written about drugs and criminal justice for the Washington Post, Salon, Quartz and more. She loves dogs and is not impressed by rodeo food. Find Keri on LinkedIn and Twitter.