New Prescriber’s Guide to the New Medicare Part D opiate dosing policies




The roadmap details our three- pronged approach to combating the opioid epidemic going forward: 1) prevention of new cases of opioid use disorder (OUD); 2) treatment of patients who have already become dependent on or addicted to opioids; and 3) utilization of data from across the country to better target prevention and treatment activities.

Most/all of chronic pain pts – especially those dealing with intractable chronic pain – will be DEPENDENT on their opiate therapy, according to this CMS release all of those DEPENDENT ON OPIATES are now officially considered to be suffering from a OPIOID USE DISORDER – the NEW TERM for someone who is has been “using opiates (legally/illegally)” > 90 days.

This policy will affect Medicare patients who have not filled an opioid prescription recently (for example, within the past 60 days) when they present a prescription at the pharmacy for an opioid pain medication for greater than a 7 day supply.

does this mean that chronic pain pts – such as myself – who are able to control their pain most of the time with NSAIDS are going to keep being “reclassified as opiate naive” and only able to get a 7 days supply ?

If you get caught up in this BS… and you are forced to pay cash to get your opiate medication to avoid cold turkey withdrawal… be cautious of the pharmacist telling you that they can rebill the insurance company once a PA is approved… Ask them what the days limits are for rebilling.. most will not be able to do it after 7-10 days after the Rx was filled.. and the PA process – unless you insist on an EMERGENCY PA – which should take 24 -72 hrs – otherwise it make take a couple of weeks…  and you may have to submit your receipt directly to the insurance company for reimbursement and what you get reimbursed may be substantially LESS than the pharmacy’s CASH PRICE.

Just remember that a NO from an insurance company is NOT IN CONCRETE… they all have appeal processes and they don’t have to tell you what the process is – or that they have one – unless you ask, then they have to provide you the process of filing an appeal in writing..  TODAY.. it is probably now a webpage.  Following the directions and the days limits  when an appeal has to be filed by.

Here is a excellent tutorial about filing appeals




One Response

  1. “…2) treatment of patients who have already become dependent on or addicted to opioids…”
    It really, really, really pisses me off to have everyone in power constantly equating physical dependency with addiction (Kolodny & Kompany did their thing well!).

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