https://reason.com/blog/2018/04/09/medicare-agency-retreats-from-arbitrary
Under the final rule, pharmacists may fill high-dose opioid prescriptions as long as they verify them.
The Centers for Medicare and Medicaid Services (CMS) has retreated from a proposed rule that would have forced many patients to choose between living in agony and shelling out thousands of dollars more every year for pain medication.
Under the original proposal, Medicare generally would not have covered prescriptions for 90 or more morphine milligram equivalents (MMEs) per day. While there were exceptions for cancer and hospice patients, other Medicare beneficiaries suffering from severe chronic pain would have been out of luck unless their doctors mounted successful bureaucratic appeals. CMS reported that 1.6 million Medicare patients received daily opioid doses of 90 MME or more in 2016.
Not surprisingly, the 90-MME cap provoked strong objections from patients and doctors. “The 90 MME hard edit guidance was strongly opposed by nearly all stakeholder groups for a variety of reasons,” CMS reported last week. “Physician groups opposed the forcible/non-consensual dose reductions due to the risks for patients of abrupt discontinuation and rapid taper of high dose opioid use. Similarly, 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.” Furthermore, “the overall consensus was that a 90 MME-per-day hard edit threshold would have little clinical impact against opioid overuse.”
The final policy adopted by CMS instead requires a pharmacist who receives a prescription above the threshold to confirm it with the doctor and document the discussion. Stefan Kertesz, the University of Alabama at Birmingham internist who organized a letter in which hundreds of physicians objected to the original plan, told The Hill the revised policy is “humane and reasonable.”
The 90-MME cutoff was copied from the supposedly nonmandatory opioid prescribing guidelines issued by the Centers for Disease Controll and Prevention in 2016. The CDC said doctors “should avoid increasing dosage” above 90 MME per day, or at least “carefully justify a decision to titrate dosage” above that level. Critics say that threshold, which many doctors have interpreted as a hard cap, is arbitrary because patients vary widely in the way they metabolize and respond to opioids, especially if they have developed tolerance after taking pain medication for years. Thanks to the CDC’s advice, patients across the country have seen their doses dramatically reduced, even when they had been responding well to opioids for years.
Given that experience, it is hard to believe the CMS did not anticipate the backlash that its “hard edit guidance” would generate. Like the CDC, it seems to be pursuing the mission of reducing opioid abuse with little thought of the consequences for innocent bystanders.
Filed under: General Problems
CMS May have backed down but what about insurance companies? Are they going to be allowed to reject our scripts if they’re over the 90 mme?
This is cruel and inhumane punishment to the disabled. To just stop pain meds after 10 years and leave the patient not only with withdrawal issues but still in pain is LUDIQUIS
But how do we get these thug dea agents and that moron sessions off the backs.of the doctors to allow them to to thier job with out fear. Doctor must be free to do thier jobs and insurance companies must be held liable for any pain and suffering caused to these patients and doctors that lost quality of life committed suicide because of unbearable pain and the lawsuits against manufacturers should all be dismissed immediately
MAKE THE DEA GO AFTER THE CRIMINALS WITH GUNS NOT DOCTORS WITH STETHASCOPES
I was just noting that last week I had seen an article proclaiming the cost of medication for seniors was about to skyrocket. Is the timing of Medicare’s “generosity a mere coincidence?? It doesn’t seem so to me at all, actually. Wouldn’t this kind of back up the idea this “crisis” is truly only about earning money from the people who are unable to work the most, too? Veterans, Seniors, CPP, Addicts???
Thank You!!
Rachel
Also, if your Pharmacist has to call your Dr. and verify this is his/her intention AND document it, pain patients will have to sit and wait in pain for the pharmacist to do this! It could take hours! And what if your prescription is due to be picked up on a weekend, or the Dr. is busy with patients, or on vacation or sick, etc. etc.?
And what of those without cars who have to have a friend pick it up? They won’t sit there and wait for hours!!! This again makes no sense and as usual, the bureaucrats don’t think it through, plus they don’t care!
My guess once the Pharmacist does it once it ost will record it your record and not keep on calling every single month. The problem will be if you hange pharmacies. The
I would refer you to the article from the Hill “CMS Tweaks Opioid Proposal After Backlash.” Scroll down to the comment from Richard Lawhern. I quote: ” However, the rule leaves in place an option for insurance companies to impose a hard edit *on their own authority* at 200 MMED. If implemented, the 200 MMED threshold will plunge hundreds of thousands of chronic pain patients into agony and disability!
See the rest of his comments.
See this is a new ,”trick,” our government has figured out on how to get their laws/opinion/morality made into law w/out actually making them law.Remember that ,”private ,” meeting on our dime the government had w/all the insurance companies,,kolodny etc..Welll what are government is doing,,,and I am not joking,,,what the government is doing,,,is allowing the private business,ie insurance companies ,,pharmacist companies,,doctors ,,enforce the new limit of 90 me,,,see the government knows,,there are laws governing a government from denial of accesss,,,as Steve has pointed out several times,,,,but,,,,private businesss are not subjected to the same laws,,,they are a private entity and can get away w/enforcing ”laws,” our government cannot abide by.Private business have no constitutional laws do they,,,,thus they can literally be the government enforcer of all the opiatephobia regulation the government cannot get away with,,,understand??Plus the dea will still use this 90 me in a court of law,,,,THIS HAS BECOME THEE DARK AGE OF MEDICINE,,,KOLODNY HAS DESTROYED MEDICAL CARE FOR THE MEDICALLY ILL,,,AND MADE HIMSELF RICH,,,,HIM AND HIS BUDDIES ARE FILTHY RICH NOW A DAYS W/PATIENT BEING FORCED INTO REHABS,,USE HIS SUBOXONE,,WHICH DADDY HAS STOCK IN,,ETC,,,andrew kolodny and his cronies have destroyed medical health care as we know it,,The government is using private business to enforce thier moral authority they cannot under the laws founding this country,,,Medicine is now only about $$$$,,,and the chronic medically ill in physical pain,,do not contribute to their bottom line,,,soo they literally planned on tortureing us death,,literally,,,and allowed another psychopathic psychiatrist to kill us off.Which btw,,would be #11 psychiatrists in history to commit a psychopathic cruel act/experaments on the human species,,,maryw