Medicare Formulary Coverage Restrictions for Prescription Opioids, 2006 to 2015
Authors: Elizabeth A. Samuels, Joseph S. Ross, Sanket S. Dhruva
Journal: Annals of Internal Medicine (2017)

Letters19 December 2017Medicare Formulary Coverage Restrictions for Prescription Opioids, 2006 to 2015Elizabeth A. Samuels, MD, MPH, Joseph S. Ross, MD, MHS, and Sanket S. Dhruva, MD, MHSElizabeth A. Samuels, MD, MPHYale University, Yale New Haven Hospital, and Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut (E.A.S.)Search for more papers by this author, Joseph S. Ross, MD, MHSYale University and Yale New Haven Hospital, New Haven, Connecticut (J.S.R.)Search for more papers by this author, and Sanket S. Dhruva, MD, MHSYale University and Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut (S.S.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1823 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Over the past 2 decades, prescription opioid sales and overdose deaths have quadrupled (1). Risk for unintentional overdose is increased when longer-acting opioids and higher dosages are prescribed (2, 3). Older patients are particularly vulnerable to opioid-related complications and injury (4). Addressing these risks, the 2016 opioid prescribing guidelines from the Centers for Disease Control and Prevention (2) suggest a trial of nonopioid therapies before opioid initiation, use of opioids only when expected benefits outweigh risks, reassessment of risks and benefits when prescribing dosages greater than 50 morphine milligram equivalents (MME) per day, and prescribing no more than 90 ...References1. Centers for Disease Control and Prevention. Prescribing data. Updated 30 August 2017. Accessed at www.cdc.gov/drugoverdose/data/prescribing.html on 1 July 2017. Google Scholar2. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016;65:1-49. [PMID: 26987082] doi:10.15585/mmwr.rr6501e1 CrossrefMedlineGoogle Scholar3. Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305:1315-21. [PMID: 21467284] doi:10.1001/jama.2011.370 CrossrefMedlineGoogle Scholar4. Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, et al. Relationship of opioid use and dosage levels to fractures in older chronic pain patients. J Gen Intern Med. 2010;25:310-5. [PMID: 20049546] doi:10.1007/s11606-009-1218-z CrossrefMedlineGoogle Scholar5. García MC, Dodek AB, Kowalski T, Fallon J, Lee SH, Iademarco MF, et al. Declines in opioid prescribing after a private insurer policy change—Massachusetts, 2011-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1125-31. [PMID: 27764082] doi:10.15585/mmwr.mm6541a1 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Yale University, Yale New Haven Hospital, and Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut (E.A.S.)Yale University and Yale New Haven Hospital, New Haven, Connecticut (J.S.R.)Yale University and Veterans Affairs Connecticut Healthcare System, New Haven, Connecticut (S.S.D.)Disclaimer: The authors assume full responsibility for the accuracy and completeness of the ideas presented, which do not represent the views of the U.S. Department of Veterans Affairs or any other supporting intuitions.Financial Support: This project was not supported by any external grants or funds. Dr. Samuels is supported by the National Clinician Scholars Program. Dr. Dhruva is supported by the Robert Wood Johnson Foundation Clinical Scholars Program. Drs. Samuels and Dhruva are supported by the U.S. Department of Veterans Affairs.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1823.Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Samuels (e-mail, elizabeth.[email protected]edu). Data set: Available for purchase from the Centers for Medicare & Medicaid Services (www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/NonIdentifiableDataFiles/PrescriptionDrugPlanFormularyPharmacyNetworkandPricingInformationFiles.html).This article was published at Annals.org on 10 October 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCommercial and public payer opioid analgesic prescribing policies: a case studyUS Trends in Opioid Access Among Patients With Poor Prognosis Cancer Near the End-of-LifeCancer pain self‐management in the context of a national opioid epidemic: Experiences of patients with advanced cancer using opioidsReduced Opioid Prescribing by Oncologists: Progress Made, or Ground Lost?A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program dataAssociation of Formulary Exclusions and Restrictions for Opioid Alternatives With Opioid Prescribing Among Medicare BeneficiariesAn Effective Intervention: Limiting Opioid Prescribing as a Means of Reducing Opioid Analgesic Misuse, and Overdose DeathsMedicare Formulary Coverage and Restrictions for Opioid Potentiators from 2013 to 2017Mitigating Responses to the Opioid CrisisA Health Plan’s Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid UsePrescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial InsurersBattling Opioid Overprescription Among the Elderly: Medicare Appears to Be Asleep at the WheelBattling Opioid Overprescription Among the Elderly: Medicare Appears to Be Asleep at the Wheel 19 December 2017Volume 167, Issue 12Page: 895-896KeywordsAddictionDisclosureDrug therapyDrugsInformation storage and retrievalMedicareMorphineOpioids ePublished: 10 October 2017 Issue Published: 19 December 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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