Medicare Adopts CDC Opioid Rules

The U.S. Centers for Medicare & Medicaid Services (CMS) are about to take voluntary “Big Brother” guidelines proposed by the U.S. Centers for Disease Control and Prevention (CDC) one step further. CMS plans to mandate pharmacists to report doctors who may be overprescribing opioids, as well as patients who may be abusing them. Red flags would be shared with Medicare insurers, who are expected to police pharmacies, physicians and patients, potentially dropping them from the Medicare program.

For example, insurers now are to watch for patients who are given more than three opioid prescriptions and use more than three different pharmacies during a six-month period, because that could indicate painkiller addiction.

Guided by its Opioid Misuse Strategy issued last January, CMS is facing up to a steep increase in addiction and overdoses due to opioids and heroin, which often is used as a cheaper substitute by patients seeking pain relief. In 2015, deaths due to opioids (prescribed and illicit) totaled more than 33,000 in the U.S. – the highest number on record, higher than the number of people killed in traffic accidents.

Medicare’s approach most likely will impact all patients, because physicians, pharmacies and insurers have a greater stake in protecting all patients’ wellbeing.

“Soon, we should see a greater emphasis on alternative therapies for pain management, including injections, spinal cord stimulation, behavioral health and non-opiate pain medications such as topical pain creams,” said Dr. Gus Lowry of Balcones Pain Consultants. “Additionally, we should see more emphasis on widely providing rescue treatments (antidotes) for opiate overdoses, as well as treatments for opiate addiction.”

GenoRite Pharmacy, a partner of Balcones Pain Consultants, offers Opi Aid, an effective, affordable and easily administered nasal spray that reverses deadly overdose symptoms such as extreme drowsiness, slowed breathing and loss of consciousness. It also allows emergency responders more time to save that person’s life.

This antidote has a shelf life of up to six months and can be used by first responders as well as family members and significant others of those at high risk of an opioid overdose or those who’ve recently completed drug rehabilitation.