How Medicare Part D Changes May Affect Pain Management

CMS tweaked an opioid policy aimed at Medicare Part D patients that drew criticism when it was first released in draft form.

Earlier this week, CMS tweaked an opioid policy aimed at Medicare Part D patients that had drawn criticism when it was first released in draft form. Critics said it would have sharply reduced access to opioids for those with chronic pain, people with cancer or other types of pain. Two palliative care doctors said they are waiting to see if the changes are implemented in a meaningful way for their patients.

In fact, most of the more than 600 comments CMS received about the proposal—to limit the average daily morphine milligram equivalent (MME) to 90 mg a day, and to limit the duration, drew outrage from patients with painful conditions who said they took their medicine responsibly and that opioids were necessary for them to get through the day with a minimum of pain.

One 49-year-old woman from Washington wrote that she is disabled because of ankylosing spondylitis, fibromyalgia, and Crohn disease. Her Part D insurer denied her monthly pain medications in February, and she wrote, “It took weeks to unravel the mess. My doctor spent hours on the phone, increasingly enraged at the insurer's untrained and inept staff, their lack of understanding of their own policies, and his frustration at simply trying to authorize the same medications he's deemed medically appropriate for me for years. My pharmacist similarly spent hours on the phone with them. As did I. It's madness.”

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