Doctors may prescribe opioids, a class of drugs used to treat pain, after surgery or an injury. Although opioids can be an important part of treatment, they have serious risks like addiction, abuse, and overdose, especially if used continuously. That’s why Medicare is working with doctors and pharmacists to perform safety checks to help you use opioids safely. Medicare is also using drug management programs to look for potentially high-risk opioid use.
These checks and programs generally won’t apply to you if you have cancer, are in hospice, get palliative or end-of-life care, or if you live in a long-term care facility.
Safety checks at the pharmacy
When a prescription is filled at the pharmacy, your Medicare drug plan performs additional safety checks and may send your pharmacy an alert to monitor the safe use of opioids and certain other medications.
These safety checks may cover situations like possible unsafe amounts of opioids, the first prescription fills for opioids or the use of opioids at the same time with benzodiazepines (commonly used for anxiety and sleep). If your pharmacy can’t fill your prescription as written, the pharmacist will give you a notice explaining how you or your doctor can call or write to your plan to ask for a coverage decision. Visit the Medicare drug plan coverage rules page for more information about safety checks.
Drug management programs
As of January 1, 2019, some Medicare drug plans have a drug management program in place to help you use opioids safely. If you get opioids from multiple doctors or pharmacies, your drug plan may talk with your doctors to make sure you need these medications and are using them safely and appropriately.
Safety checks and drug management programs are just some of the ways that Medicare, Medicare drug plans, and pharmacies are working together to make sure you’re getting the pain relief treatment you need while keeping you safe. Read your Medicare drug plan’s materials for more information on their specific drug coverage rules.