Safe Use of Opioid Pain Medication

Important Notice on MAPD HMO Plan Termination Effective March 1, 2020

Effective February 29, 2020, Quality Health Plans of New York (QHPNY) will terminate its contract with the Centers for Medicare and Medicaid Services (CMS).

Quality Health Plans of New York won’t offer Medicare plans after February 29, 2020. This means coverage through Quality Health Plans of New York will end February 29, 2020.

It has been our honor to serve you. Quality of Health Plans of New York would like to thank you for the opportunity and sincerely apologizes for any inconvenience this may cause.

For more information members should refer to the notices recently mailed or call Customer Service at 1 (877) 233-7058 (TTY/TDD: 711). Until March 31st, you can call us 7 days a week from 8:00 a.m. to 8:00 p.m. and from April 1 to April 30th, you can call us Monday through Friday from 8:00 a.m. to 8:00 p.m.

You may also call 1-800-MEDICARE (1-800-633-4227). Tell them your plan isn’t going to be offered after February 2020 and you want help choosing a new plan. This toll-free help line is available 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.


Safe Use of Opioid Pain Medication – Information for QHPNY Members

Prescription opioid pain medications—like oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and codeine—can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose, and death. These risks increase with the higher the dose you take, or the longer you use these pain medications, even if you take them as prescribed. Your risks also increase if you take certain other medications, like benzodiazepines (commonly used for anxiety and sleep), or get opioids from many doctors and pharmacies.

Medicare is dedicated to helping you use prescription opioid pain medications more safely, and is introducing new policies for opioid prescriptions in the Medicare Part D prescription drug program beginning in January 2019.

Safety reviews when opioid prescriptions are filled at the pharmacy

Your Medicare drug plan and pharmacist will do safety reviews of your opioid pain medications when you fill a prescription. These reviews are especially important if you have more than one doctor who prescribes these drugs. In some cases, the Medicare drug plan or pharmacist may need to first talk to your doctor.

Your drug plan or pharmacist may do a safety review for:

  • Potentially unsafe opioid amounts
  • If you take opioids with benzodiazepines like Xanax, Valium, and Klonopin
  • New opioid use—you may be limited to a 7-day supply or less. This does not apply to you if you already take opioids.

If your pharmacy can’t fill your prescription as written, including the full amount on the prescription, the pharmacist will give you a notice explaining how you or your doctor can contact the plan to ask for a coverage decision. If your health requires it, you can ask the plan for a fast coverage decision. You may also ask your plan for an exception to its rules before you go to the pharmacy, so you’ll know if your plan will cover the medication.

Talk with your doctor

Talk with your doctor about all your pain treatment options including whether taking an opioid medication is right for you. There might be other medications you can take or other things you can do to help manage your pain with less risk. What works best can be different for each patient. Treatment decisions to start, stop or reduce prescription opioids are individualized and should be made by you and your doctor. For more information on safe and effective pain management, visit https://www.cdc.gov/drugoverdose/patients/.

Additional Resources

Contact your Medicare drug plan for additional information. You can find contact information in your member materials or on your membership card.

Other resources include:

For more information on what Medicare covers and drug coverage rules, visit Medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.