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CMS Plan to Restrict Sale of Pain Drugs Opposed by AMA

Cheryl Clark, for HealthLeaders Media, March 6, 2012

A federal plan calling for Medicare Advantage Part D sponsors to deny potentially unsafe pain drugs such as hydrocodone and oxycodone—perhaps to patients who may be "doctor shopping"—has incurred strong objection from the American Medical Association.

The 131-page "advance notice" from the Centers for Medicare and Medicaid Services, which would take effect Jan. 1, 2013, calls for Part D sponsors to employ more effective ongoing and retrospective drug utilization reviews, or layers of formulary management, for each of their enrollees. The goal is to protect them from receiving harmful quantities of any drug, as well as minimize overutilization.

CMS says that overdoses of such drugs can occur when patients get prescriptions for the same or similar opioids from multiple physicians. Drugs that contain the same potentially harmful ingredient, such as acetamenophen, may become harmful, as doses would accumulate in the patient, the letter says.

"We believe that if point-of-sale (POS) safety edits, such as "therapeutic duplication," "maximum dose exceeded," "refill too soon," or quantity limits (QLs) were appropriately implemented, such egregious overutilization can be averted," the agency said. The new policy is outlined in CMS's "Advance Notice of Methodological Changes for Calendar Year (CY) 2013 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2013 Call Letter," published February 17.

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3 comments on "CMS Plan to Restrict Sale of Pain Drugs Opposed by AMA"


rrpostal (12/4/2012 at 4:42 PM)
Oh my. I work for medicare and this is going to swamp us in people screaming for their meds. "Cutting people off" from their relatively safe and regulated medication is not the proper way to combat addiction. People will resort to crime and illicit drugs. The amount of medicare patients on pain meds is astounding, but hardly a huge cost issue, which is what I'd rather they worry about. If someone is going to be getting stoned on opiates, I'd much rather they do it at their pharmacy than the street corner.

RICK (3/7/2012 at 10:46 AM)
CMS = Constant Mental Struggle. Just more proof that CMS stinks.

B S (3/6/2012 at 9:36 AM)
Of course this is all about patient safety - that's why the Government Accountability Office (A financial and budgeting entity) triggered the action.