Taking opioid drugs: What you need to know

Providence Medicare Advantage Plans is committed to keeping you safe and healthy. Even if you’ve never taken opioids, the following information may be helpful. And if the need ever comes up, you’ll find tips on working with your doctor to help ensure safe use.

Prescription opioids are a group of drugs used to reduce moderate to severe pain. Common types of opioid drugs are oxycodone, hydrocodone/acetaminophen, and morphine. While opioids can be helpful in relieving certain types of pain, they also come with serious risks and complications. Taking opioids, especially for long periods of time, even as directed, may:

• Cause side effects like upset stomach, constipation, confusion, dizziness, depression, drowsiness, and an increase in pain sensitivity.
• Lead to tolerance, which means you might need to take more of a drug for the same pain relief.
• Create physical dependence where you suffer withdrawal symptoms (such as anxiety, nausea and vomiting) when the medication is stopped.
• Lead to serious risk of addiction and overdose. An opioid overdose, often marked by slowed breathing, can cause sudden death. This risk may be increased if opioids are taken with alcohol and other drugs (such as muscle relaxants and benzodiazepines used for anxiety and sleep).

Given the risks with taking opioids, non-opioid therapy should be considered first. In many cases non-opioid therapy may be more effective than opioids. Examples of non-opioid therapy include:

• Pain relievers like ibuprofen, naproxen, or acetaminophen
• Drugs that may help with nerve type pain (such as gabapentin or duloxetine)
• Heat or ice, massage, acupuncture, physical therapy, and exercise
• Topical pain medications such as lidocaine ointment, diclofenac gel, or capsaicin cream

Opioid therapy should be started or continued only if the expected benefits outweigh the risks. It is important that you talk with your doctor before starting and while taking these drugs.

If your doctor decides that opioids are necessary for you, here are a few ways to help keep you safe:

• As with all drugs, only take the drugs as directed.
• Talk with your doctor if you have concerns about side effects, including dependence.
• Do not drink alcohol while taking opioids.
• Check with your doctor or pharmacist to make sure it’s okay to take opioids with other drugs you are taking.
• Store all drugs in a secure place that’s out of the reach of children and others.
• Never share prescription drugs with other people.
• Follow up regularly with your doctor about your care.
• Talk to your doctor or pharmacist to see if an opioid reversal agent, naloxone (also known as Narcan®) is right for you. This drug is on the Providence list of covered drugs. Talk to your doctor or pharmacist to find out when and how to use it. Educate those close to you, including family, friends, and caregivers, on use of the device and of the key signs of an accidental overdose: slow or shallow breathing, small pupils, extreme sleepiness, or inability to wake up. This risk increases with alcohol and other drugs such as muscle relaxants and drugs for anxiety or sleep.
• Properly discard any unused medications. The following guidance may be helpful: www.hhs.gov/opioids/prevention/safely-dispose-drugs/index.html

 

Medicare Part D opioid policies

The Centers for Medicare & Medicaid Services (CMS) implemented a rule for opioid drugs beginning January 2019. This was created to promote safe use of opioids. Providence Medicare Advantage Plans continue to maintain the Centers for Medicare & Medicaid Services' (CMS) opioid prescribing policies that impact Medicare Part D members.

Safety reviews for opioid drugs

Providence Medicare Advantage Plans and your pharmacist will do safety reviews of your opioid drugs when you fill a prescription. These reviews are especially important if you have more than one doctor who prescribes these drugs. In some cases, your pharmacist may need to first talk to your doctor, or your doctor may need to submit information to Providence Medicare Advantage Plans.

Your drug plan or pharmacist may do a safety review for:

• Potentially unsafe opioid amounts.
• If you take opioids with benzodiazepines like alprazolam (Xanax®), diazepam (Valium®), and clonazepam (Klonopin®).
• If you take more than one long-acting opioid like oxycodone ER tablets (Xtampza®) and fentanyl patches. 
• Opioid use: Medicare Part D plans are required to implement a safety edit to limit initial opioid dispensing to a 7-day supply or less. It is important to know that your first prescription will be limited to a 7-day supply or less.          
  • This does not apply to you if you already take opioids. However, if you are not filling these drugs consistently (such as when being prescribed an amount that lasts longer than the day supply on the bottle), you may appear opioid naïve at the pharmacy and have issues refilling the medication. Talk to your doctor to ensure you are only prescribed the quantity you use each month to reduce issues filling this drug at the pharmacy.

If your pharmacy can’t fill your drug as written, including the full amount, your pharmacist will give you a notice explaining how you or your doctor can contact us to ask for a coverage decision. You can also visit our Pharmacy Medicare Part D Coverage Determinations, Exceptions, Appeals and Grievance page for more information on how to request a coverage decision. If your health requires it, you can ask us for a fast coverage decision. You may also ask us for an exception to our rules before you go to the pharmacy, so you’ll know if we will cover the drug.

Drug Management Programs (DMPs)

Part D plans use Drug Management Programs (DMPs) to help connect care for patients who get opioids from multiple doctors or pharmacies and may limit access to certain controlled substances defined as “frequently abused drugs,” such as opioids and benzodiazepines. Providence Medicare Advantage Plans has a DMP for opioids. If you get opioids from multiple doctors or pharmacies, we may talk with your doctors to see if there is concern around the safety of the opioids and benzodiazepines prescribed. If there are safety concerns, we may discuss alternative options with your doctor to help better manage your pain and coverage of opioids may be limited. For example, under the DMP you may need to get these drugs only from certain doctors or pharmacies to improve your health care.

Before any limits are placed, we will notify you by letter. You’ll be able to tell us which doctors or pharmacies you prefer to use to get your opioids and benzodiazepines. After you’ve had time to respond, we will send you another letter confirming if your coverage will be limited. You and your doctor can appeal if you disagree or think we made a mistake. The second letter will tell you how to contact us to make an appeal.

Note: The safety reviews and DMPs should not 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.

If you have any questions, please call Providence Medicare Advantage Plans at 503-574-8000 or 1-800-603-2340. TTY users should call 711. We are open 8 a.m. to 8 p.m. (Pacific Time) 7 days a week, October 1st through March 31st and Monday - Friday, April 1st through September 30th.

Other resources include:

• “Your Guide to Medicare Prescription Drug Coverage” at: www.Medicare.gov/publications/search
• “What do drug plans cover?” at: https://www.medicare.gov/health-drug-plans/part-d/what-drug-plans-cover
• Call the State Health Insurance Assistance Program (SHIP). Visit www.shiptacenter.org or call 1-800-MEDICARE for the phone number of your SHIP.
• For resources and information about the National Opioid Crisis, go to: www.hhs.gov/opioids
• For more information on what Medicare covers as well as 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.