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CMS issues proposed opioid overutilization policy

February 07, 2018
Area(s) of Interest: Drug Prescribing/Dispensing Patient Care 


The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would require Medicare Part D plans to place new limits on opioid prescribing that would take effect in 2019. The rule proposes the following:

  • Enhancing the Opioid Monitoring System to identify high-risk patients who use “potentiator” drugs in combination with prescription opioids to ensure that plans provide appropriate case management. (Potentiators are drugs that, when taken with an opioid, increase the risk of an adverse event.)
  • Creating a new measure to track the percentage of individuals 18 and older with concurrent use of opioids and benzodiazepine.
  • Implementing a seven day-limit on initial fills of prescription opioids for acute pain (plans have the option to set a maximum daily dose for this seven-day supply).
  • Establishing a daily limit of 90 morphine milligram equivalents of opioids for non-acute pain, with a seven-day supply limit (but plans can override this limit).

The California Medical Association is currently reviewing the proposal and will submit comments before the March 5, 2018, deadline. Click here for more information.

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