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:
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-04-03.html.
The 2018 Rate Announcement and Call Letter, and the Request for Information may viewed through:
https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents.html and selecting “2018 Announcement.”
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4 thoughts on “Medicare Sets NO Maximum Opioid Dose

  1. mike house

    Thank God!
    I start medicare in september. kaiser , witgout regard to my health has been reducing my pain medication along with millions of others under the guise of the cdc guidelines. As they have been reducing my pain has been comong back full force. Some days i cant even get out of bed. ive had phys. therapy, episurals,direct injections and more. the only thing that work to get my pain to a 2 or 3 is the higher dose opioid medication. The standard excuse feom the was not mesically necessary. If nd that seriously disgustjng. FOUR YEARS FROM PAIN DOCTORS AND 3 FEOM KAISER GIVING ME THE SAME MEDICATION MO TH AFTER MONTH. GREAT PATIENT. NEVER CALLED IN WITH EXCUSES. TAKE MY MEDICATION AS DIRECTED PASSED EVERY IRIN TEST. STILL THEY WOULD RATHER ME AND OTHERS BE IN TERRIBLE PAIN. THEY MUST BE SAVING BILLIONS IN DEUG COSTS AND HAVE NO REGARD FOR HUMAN COST. I UNDERSTAND THERE IS A OPIOID PROBLEM. IT JAS BEEN A PROBLEM FOR CENTURIES. THE JUNKIES DONT EVEN WAN THE PAINEDS ANY MORE. HEROIN IS EASIER TO GET AND STRONGER.
    THE MILLIONS OF LEGITIMATE CHRONIC PAIN PATIENTS ARE SUFFERING TO NO END BECAUSE OF THIS. NAIVE POLITICIANS LIKE CHRIS CRISRIE HAVE NO CLUE TO THE RATW OF SUICIDED AND OVERDOSES THAT WILL HAPPEN IN HIS STATE AND OTHERS THAT ALLOWED THE PENDULLUM TO SWING TOO FAR. I WAS TOLD BY LAISER WE ARE COLLATERAL.DAMAGE. I JUST KNOW THAT FOR AN ADDICT 1PAIL PILL IS TOO MANY AND A TBOUSAND ISNT ENOUGH. SOO BY LIMITING TRUE PATIENTS THAT USE TJEIR MEDICATION AS DIRECTED TO 1/3 OF WJATS NEEDED WIL CAUSE UNDUE HARM AND POSSIBLY TEMPT THEM TO LOOK TO TJE STREETS. I HAVE NEVER GOT HIGH FROM THE PILLS AND I TAKE A LOT. THOSE JUNKIES ARW MIXING WITH BOOZE VALIUM COCAINE OR WHAT EVER TO GET HIGH. THEYRE DESTINED TO OVERDOSE OR DIE, WHETHER CHRONIC PAIN PATIENTS GET THIER MEDICINE OR NOT. I APPLAUD MEDICARE FOR PUTTING THE DOSAGE CONTROL IN THE HANDS OF THE DOCTOR.
    I DO BELIEVE OCCASIONAL URIN TESTING AND PROOF OF PAIN BY MRI OR XRAY IS NECESSARY TO CONTROL. THE NATIONAL DATABASE IS A GREAT WAY TO MALE SURE PEOPLE ARENT DOCTOR SHOPPING. WE CAN ALL BE SATISFIED AS LONG AS THE RULES ARW FAIR PATIENTS AND DOCTORS DO THE RIGHT THING AND JUNKIES GET TREATMENT WHEN READY. NO CDC GUIDELINE OR COURT RULE WILL STOP TJEM. THEY MUST HIT A ROCK BOTTOM
    OTS TIME RO STOP BLAMING THE MEDICATION OR THE DOCTORS. ITA THE INDIVIDUAL LAWBREAKERS TO BLAME. THEY MADE THE CHOICE TO MISUSE AND ABISE OPIOIDS. ITS BEEN COMMON KNOWLEDGE FOR CENTURIES OPIOIDS WHEN ABUSED CAUSE ADDICTION. ots also common knowledge that millions of aging Americams are living with terriblw chronic pain and thay are dependent on this medication for a quality life, no different then a diabetic is dependent on insulin for a quality life. SNAKE OIL SOLUTIONS ARE COMING UP FROM EVERY CORNER. THEY DONT WORK. THE GOLD STANDARD HAS, IS AND WILL BE THE GOLD.STANDARD.FOR.PAIN RELIEF THEN , NOW AND THE FORSEEABLE FITURE.
    THANK YOU!

    Liked by 1 person

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  2. scott michaels

    I sure hope this is true i am leaving kaiser becaise thay jave been reducing me and my pain is getting much worse
    After ten years no problems poster child pain PATIENT. I’ve been cut by almost half. And they are going to take 75% of that away.
    I am literalllly dying and they truly don’t care. I have done and called everybody wrote letter to CEO and on an on. MY DR THINKS IT’S WRONG I ACTUALLY RECORDED A VISIT. NUT THE SUOTS SAY IT NOT MEDICALLY NECESSARY FOR ANYBODY UNLESS YOUR DYING OR HAVE CANCER. They said im COLLATERAL damage. I said I’d like 1% of the savings they’ll have from denying treatment for patients in sever daily pain!

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