February 2019

Safer Use of Opioid Pain Medication

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 rescription 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 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 multiple doctors and pharmacies. Medicare is dedicated to helping you
use prescription opioid pain medications more safely.

Safety reviews at the pharmacy
When you fill a prescription at the pharmacy, Medicare drug plans and pharmacists
routinely check to make sure the prescription is correct, that there are no interactions,
and that the medication is appropriate for you. They also conduct safety reviews to
monitor the safe use of opioids and other frequently abused medications. 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 before the prescription can be filled.
Your drug plan or pharmacist may do a safety review when you fill a prescription if you:
•  Take potentially unsafe opioid amounts as determined by the drug plan or
pharmacist.
•  Take opioids with benzodiazepines like Xanax®, Valium®, and Klonopin®.
•  Are newly using opioids—you may be limited to an initial 7-day supply or less, to
decrease the likelihood of addiction or long-term use.
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. 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. Visit Medicare.gov/
claims-appeals/file-an-appeal/medicare-prescription-drug-coverage-appeals to learn
how to ask for an exception.

 Drug Management Programs
Some Medicare drug plans (Part D) will have a Drug Management Program to help
patients who are at risk for prescription drug abuse. If you get opioids from multiple
doctors or pharmacies, your plan may talk with your doctors to make sure you need
these medications and that you’re using them safely.
If your Medicare drug plan decides your use of prescription opioids and
benzodiazepines may not be safe, the plan may limit your coverage of these drugs.
For example, you may be required to get these medications only from certain
doctors or pharmacies to better coordinate your health care.
Before your Medicare drug plan places you in its drug management program, it will
notify you by letter, and you’ll be able to tell the plan which doctors or pharmacies
you prefer to use. You and your doctor can appeal if you disagree with your plan’s
decision or think the plan made a mistake.
Note: The safety reviews and Drug Management Programs generally won’t apply
to you if you have cancer, get hospice, palliative, or end-of-life care, or if you live
in a long-term care facility.

Talk with your doctor
Talk with your doctor about all your pain treatment options, including whether
taking an opioid medication is right for you. You might be able to take other
medications or do other things to help manage your pain with less risk. What
works best is 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
CDC.gov/drugoverdose/patients/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.

You have the right to get Medicare information in an accessible format, like large print, Braille, or
audio. You also have the right to file a complaint if you feel you’ve been discriminated against.
Visit Medicare.gov/about-us/accessibility-nondiscrimination-notice, or call 1-800-MEDICARE
(1-800-633-4227) for more information. TTY users can call 1-877-486-2048.
Paid for by the Department of Health & Human Services.

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CMS Product No. 12033