Medicare Finalizes Opioid Restriction Plan That Will Massively Impact Pain Patients

Medicare Finalizes Opioid Restriction Plan That Will Massively Impact Pain Patients

Doctors believe the strict, new policy will have negative health consequences for pain patients. 

woman in pain holdng her upper arm

On Monday, Medicare revealed a host of new policy changes for 2019 including a policy that will prevent the government insurance program from covering long-term, high-dose opioid prescriptions—a vast change for the program, which had one-third of beneficiaries prescribed opioids in 2016.

Here’s are a few of the final, updated policies:

  • Medicaid plan sponsors will implement a hard safety edit to limit initial opioid prescription fills for the treatment of acute pain to no more than a 7-day supply for new opioid users.
  • For chronic opioid users, Medicare plan sponsors will implement real-time safety alerts at the time of dispensing, as a proactive step to engage both patients and prescribers about overdose risk and prevention.
  • Medicare plan sponsors will implement additional soft safety edits to alert the pharmacist about duplicative opioid therapy and concurrent use of opioids and benzodiazepines.

Doctors—even those well-versed in the dangers of opioids—say that the new policy to taper the drugs is a governmental overreach that could have negative health consequences for patients. 

“The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine, told The New York Times. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”

Under the new policy, which will take effect in January 2019, Medicare would not cover opioid prescriptions that last for more than a week and are equal to 90 milligrams of morphine daily (the morphine equivalency is a standard way to measure the power of opioid prescriptions).

There would be exceptions for cancer patients and those in hospice. The change would affect an estimated 1.6 million of the 43.6 million Medicare recipients. 

Two hundred and twenty experts in medicine, addiction treatment and pain management, as well as patient advocacy groups, have signed a letter opposing the policy change. 

Dr. Stefan G. Kertesz, who teaches addiction medicine at the University of Alabama at Birmingham, said that he has had patients consider suicide when faced with the prospect of being weaned to a lower dose of their pain medication. 

“A lot of the opioid dose escalation between 2006 and 2011 was terribly ill advised,” he said. “But every week I’m trying to mitigate the trauma that results when patients are taken off opioids by clinicians who feel scared. There are superb doctors who taper as part of a consensual process that involves setting up a true care plan. But this isn’t it.”

A recent study found that opioids are no more effective than over-the-counter and non-opioid alternatives for relieving chronic pain. However, Dr. Erin E. Krebs, the lead author of that study, signed the opposition letter to Medicare. 

“My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people—even if opioids have no benefit for their pain,” she said. “Even if we walk away from using opioids for back and knee pain, we can’t walk away from patients who have been treated with opioids for years or even decades now. We have created a double tragedy for these people.”

114 Responses

  1. Most People On Medicare are Disabled or Retired. .What Is Wrong With Them! These People like Myself are Not Addicts. I have Suffered With Chronic Pain For Over 20yrs. I Have Had 14 Sugeries On My Arms and Hands 24 Surgeries Altogether. I Have Taken Care of The Elderly for Over 30yrs and Now My Elderly Husband Takes Care of Me. I Went on Disability IN 2008 Because My Arms Are Shot.,I Have Suffered Tremendously Enduring 2 Rods Put In My Wright Wrist Leaving Me With Severe Arthritis In My Hand And All Fingers. I Have a Huge Hole In My Other Hand From a Simple Carpal Tunnel Surgery That Left Me To Endure 4 More Surgeries and a 28 Day Hsp Stay. I Had Developed an Infection From A Stomach Surgery Also Leaving Me With a 15 Painful Hsp Stay. I Have Had 3 Unessary Elbow Surges Leaving Me To Endure 2 More and a Total Elbow Reconstruction. I Was Diagnosed Also With 16 Painful Diagnoses That Have No Cure and Will Continue to Get Worse. Osteoarthritis Of The Cervical Spine. . Neural ForminslSpinal Stenosis..Severe Multilevel Degenerate Disc Disease. .Radicuphaty of the Cervical Region. .Degenerate Joint Disease. .Central Pain Syndrome ..Facet Arthritis ..MyofascialPain. .Chronic MuscularPain Disorder. .Sacroiliac Joint Dysfunction. .Osteoarthritis Of Both Hips with Tears ..Cysts and Spurring. .Osteoarthritis of The Right Knee. .Degenerate Arthritis of The Wrist and Hands. .Scar Tissue Pain From Multilevel Elbow Surgeries ..Chronic Pain. .Severe Numbness in Both Hands and Feet. .Raynauds Disease ..RSD.. Along With Many Other Medical Issues Inluding Hypertension and Depression. So Now They Have Cut Back On The Only Medication Was Easing My Pain and Giving Me Quality of Life. They Want Me to Endure 5 More Surgeries Including another Plate In My Foot..Neck Surgery. .2 Hip Replacements. .A Total Keep Replacement . Why Because Someone Decided To Get High and The Government is Counting Heroin and Illegal Fentaynal and Pills Coming In From China as Perscription Overdoses . Now Even if I Could Get a Doctor to Perscibe My Insurance Won’t Cover it! Why Punish The Innocent for the Mistakes of Others. We Have to Stop This Inhumane Treatment of Honest Americans! We Cannot Let The Elder and Disable Suffer. We Are Not Drug Addicts ..We Are In Pain! America Has Lost All Common Sense . All Because They Want to Be Rewarded for Helping The Opiod Crisis. .While Millions Suffering Because Perscription Medication Did Not Start This Crisis and Now We Face A Much Bigger Problem and Indurable Companies Do Not Care About The Elderly and Disabled. How Sad.

Leave a Reply

%d bloggers like this: