Opioid epidemic drives new federal policies

 In 2017 the US Department of Health and Human Services (HHS) declared a public health emergency to address the national opioid crisis. More than 115 people in the US die daily due to opioid overdose and the Centers for Disease Control estimates that prescription opioid misuse costs the US $78.5 billion a year.  To address the crisis, Centers for Medicare and Medicaid Services announced many new requirements for the 2019 plan year. 

In order to comply with new CMS requirements as well as to promote better opioid prescribing and prevent opioid misuse/abuse, UnitedHealthcare Medicare & Retirement providers of our Medicare Advantage Plan, will be implementing the following new opioid management strategies effective 1/1/2019,:

  • 1-month supply restriction at both retail and mail
  • First-fill 7-day supply limit for individuals new to opioid therapy
  • Cumulative opioid safety reduction to 200 morphine milligram equivalent (MME) per day when opioids are prescribed by 2 or more providers
  • Capability to limit opioid coverage for at-risk individuals to certain prescribers and/or pharmacies

These new strategies will apply to long-acting and short acting opioid prescriptions in 2019.  Members who are in hospice care or being treated for a cancer-related pain will be excluded from these new safety edits except for the 1-month supply limitation. The 1-month supply limitation is intended to prevent opioid misuse/diversion by limiting the amount of opioids a member can have on hand at a given time.  Members and providers will be notified of these changes prior to 1/1/19.

These rules currently only affect our retirees, but it’s possible that these changes will start to be adopted by other health insurance plans.  Benefits Division is tracking the issue and will provide updates as new information becomes available. 

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