CMS is expected to publish the final version of a proposed rule in April to limit opioid prescriptions to seven days. The rule, which will not apply to beneficiaries with cancer or in hospice care, has drawn sharp critique from both patients and physicians who would fall under its purview, according to The New York Times.
Here are five things to know.
1. CMS drafted the rule in response to the overprescription of opioids among beneficiaries. In 2016, one-third of Medicare's 43.6 million enrollees received an opioid prescription, according to HHS' Office of the Inspector General. CMS opened the rule for comment Dec. 27, 2017. The comment period ended March 5, and the agency is scheduled to publish the final rule April 2.
2. The proposed rule would limit opioid prescriptions equivalent to 90 milligrams or more of morphine to seven days, effective Jan. 1, 2019. More than 1.6 million Medicare recipients currently have opioid prescriptions that exceed this limitation, according to the Times.
3. Critics say the rule allows the government to interfere with the patient-physician relationship and will likely send many patients who've been using opioids long-term for pain management into withdrawal, thereby increasing their risk of turning to more deadly illicit opioids like heroin and illegally distributed fentanyl.
"The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient," Joanna Starrels, MD, an opioid researcher and associate professor at Albert Einstein College of Medicine in New York City, told the Times. "That takes a lot of clinical judgment. It's individualized and nuanced. We can't codify it with an arbitrary threshold."
4. CMS' move falls in line with numerous private insurers and more than 20 states that have implemented opioid prescription limits for acute pain. CMS' proposal derives its limitations from CDC's opioid prescribing guidelines. However, some say CMS misinterpreted these guidelines as they are designed to apply to individuals beginning opioid therapy for acute pain, rather than those who've already been using the medications for an extended period.
5. Lewis Nelson, MD, chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital in Newark, N.J., worked on the CDC guidelines and told the Times the group "didn't take a specific position" on patients already taking high opioid doses.
"We did say that established, high-dose patients might consider dosage reduction to be anxiety-provoking, but that these patients should be offered counseling to re-evaluate," Dr. Nelson said. "There is a difference between a CDC guideline for doctors and a CMS hard stop for insurers and pharmacists."
To read the Times' full report, click here.
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