CMS tweaks opioid proposal after backlash

The Centers for Medicare and Medicaid Services (CMS) has released a sweeping final Medicare rule that included altering a draft proposal aimed at curbing the opioid epidemic that had proven controversial.

The agency had received pushback on a proposal that would have meant a prescription for high doses of opioids (90 milligrams of morphine per day or more) automatically wouldn’t be filled and the patient would need special permission from their private insurance company in order to receive the medication.

Many doctors and patients expressed opposition during the draft proposal’s public comment period, which ended March 5, and the proposal “was strongly opposed by nearly all stakeholder groups for a variety of reasons,” CMS wrote in its final letter on new Medicare policies released Monday.

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“We received hundreds of letters from patients who have taken opioids for long periods of time and are afraid of being forced to abruptly reduce or discontinue their medication regimens with sometimes extremely adverse outcomes, including depression, loss of function, quality of life, and suicide,” CMS wrote.

The “overall consensus,” CMS wrote, “was that a 90 MME-per-day hard edit threshold would have little clinical impact against opioid overuse.”

The final policy is different than what was proposed. When a pharmacist receives a prescription for a dosage of 90 milligrams of morphine or more per day, they will be required to talk to the prescriber, document the discussion and if the prescriber approves, then they can fill the prescription.

A CMS official said that in most cases, this should likely make for a faster process than what was originally proposed, saying it would “fit within the current workflow of what the pharmacist is already doing to verify the prescriptions, speaking with the patient and the prescriber.”

The aim is “to create an effective mechanism and create that re-assessment and monitoring and care coordination and not being overly burdensome,” the official said.

Dr. Stefan Kertesz, professor of medicine at the University of Alabama Birmingham School of Medicine, help lead a letter in opposition to the original draft proposal, which garnered over 220 signatures from academic medical professors, addiction experts and more.

He said the final policy, having the pharmacist check with the provider, is more reasonable.

“I think it’s humane and reasonable, but there is some point at which that’s not the strongest way to protect and create safety for people who are receiving opioids.”

Lawmakers and the Trump administration have been working to find ways to curb the opioid epidemic, which has shown no signs of abating.

Deaths involving opioids increased nearly 28 percent from 2015 to 2016, according to the latest data from the Centers for Disease Control and Prevention.