.png)
Prescription opioid medications — such as oxycodone, hydrocodone, morphine and codeine — can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, an overdose and death.
Those risks increase the higher the dose you take or the longer you use the pain medications, even if you take them as prescribed. Your risks also grow if you take certain other medications, like benzodiazepines (commonly used for anxiety or sleep), or if you get opioid medications from many doctors or pharmacies.
More than 11 million Americans misuse prescription opioids every year. In fact, opioid misuse has become so prevalent that the government has declared it a public health emergency. Opioid overdoses accounted for 47,600 deaths in 2017, and 40 percent of those deaths involved a prescription opioid medication.
For years, Americans overestimated the benefits of opioids and underestimated the risks. Many people became regular users of the pain killers, often quite innocently, with a prescription from a doctor after surgery or an injury or as treatment for a chronic condition. Few thought their growing dependence would lead to addiction.
Medicare is working closely with drug plans, pharmacists and health care providers to ensure that beneficiaries use these powerful pain medications appropriately. Federal health care officials recently introduced new guidelines for opioid prescriptions in the Medicare Part D drug program. Here’s a brief overview of the safety measures:
- Your Medicare drug plan and pharmacist may do safety reviews of your opioid pain medications when you fill a prescription. The reviews are especially important if you have more than one doctor who prescribes these drugs. In some cases, the Medicare drug plan or pharmacist may need to talk to your doctor before filling the prescription.
- Your drug plan or pharmacist may do a safety review if they determine you’re taking potentially unsafe opioid amounts, or if you take opioids with benzodiazepines (like Xanax, Valium or Klonopin) or if you’re using opioids for the first time. New users may be limited to an initial seven-day supply or less to reduce the possibility of long-term use and addiction.
- If your pharmacy can’t fill your prescription as written, the pharmacist will give you a notice explaining how you or your doctor can contact your drug plan to ask for a coverage decision. If your health requires it, you can request a fast decision. You may also ask your plan for an exception to its rules before you even go to the pharmacy, so you’ll know if it will cover your medication.
- Some Medicare drug plans will have a drug management program to help patients who are at risk for prescription drug abuse. If you get opioids from more than one doctor or pharmacy, your plan may talk with your doctors to make sure you need the medications and are using them safely.
- If your drug plan decides your use of prescription opioids and benzodiazepines may not be safe, the plan may limit your coverage of those drugs. For example, you may be required to get your medications only from certain doctors or pharmacies to better coordinate your health care.
- Before the drug plan places you in a drug management program, it will notify you by letter, and you’ll be able to tell the plan which doctors or pharmacies you prefer to use. If your plan decides to limit your coverage for these medications, it will send you another letter confirming that. You and your doctor can then appeal if you disagree with the decision or think it is a mistake.
It’s important to note that the safety reviews and drug management programs generally won’t apply to you if you have cancer, get hospice, palliative or end-of-life care, or live in a long-term care facility.
Talk with your doctor about all your pain treatment options, including whether taking an opioid medication is right for you. You may be able to take other medications or do other things to help manage your pain with less risk. Decisions to start, stop or reduce prescription opioids should be made by you and your doctor. What works best is different for every patient. For more on Medicare’s drug coverage rules, visit Medicare.gov or call 1-800-633-4227.
