Medicare Sets NO Maximum Opioid Dose

CMS finalizes 2018 payment and policy updates for Medicare Health and Drug Plans, and releases a Request for Information – 2017-04-03

The final policies are similar to those proposed and discussed in the Advance Notice and draft Call Letter in February but incorporate several changes in response to feedback received during the public comment period.

CMS apparently read our comments and reacted to them, unlike the CDC, which completely ignored input on their opioid prescribing guidelines.

This is the first national policy to give authority back to physicians to manage opioid medications for chronic pain patients. It could be a sign that the medical industry is finally reconsidering its rash generic restrictions on what should be a treatment plan developed by doctors with their patients. 

CMS is also finalizing policies that will further combat opioid overutilization by

  1. encouraging safeguards before an opioid prescription is dispensed at the pharmacy, while
  2. preserving flexibility that will maintain access to needed medications for Medicare enrollees in the Part D prescription drug benefit.

CMS believes that Medicare Advantage Organizations and Part D sponsors, working with prescribing physicians, are in the best position to identify and employ best practices and the most appropriate care management interventions for enrollees using high dosage opioids.

CMS expects all Part D sponsors to focus on improving the coordination of care among these enrollees using high dosage of opioids, and in particular, Medicare Advantage plans that include prescription drug coverage should consider expanding the care management they provide enrollees.

In addition to today’s payment and policy updates for Medicare Advantage and Part D, CMS is releasing a Request for Information to welcome continued feedback on Medicare Advantage and Part D.

CMS is accepting comments on the Request for Information through April 24, 2017.

For a fact sheet on the 2018 Rate Announcement and Call Letter, please visit:
The 2018 Rate Announcement and Call Letter, and the Request for Information may viewed through: and selecting “2018 Announcement.”

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