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/.
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:
- “Your Guide to Medicare Prescription Drug Coverage” at: Medicare.gov/publications
- “How Medicare Drug Plans use Pharmacies, Formularies, & Common Coverage Rules” at: https://www.medicare.gov/Pubs/pdf/11136-Pharmacies-Formularies-Coverage-Rules.pdf
- Call the State Health Insurance Assistance Program (SHIP). Visit shiptacenter.org or call 1-800-MEDICARE for the phone number of your SHIP.
- For resources and information about the National Opioid Crisis go to: hhs.gov/opioids or the Center for Disease Control (CDC) at: https://www.cdc.gov/drugoverdose/epidemic/index.html
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.