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4 Facts About Medicare’s New Opioid Policies

The Trump administration is responding to the opioid epidemic with new policies to help keep people with Medicare safe. We know opioids like oxycodone (OxyContin®), hydrocodone (Vicodin®), morphine and codeine can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose and death. Even if you take opioids as prescribed, higher doses and longer use increase your chances of facing these risks.

If you’re a person with Medicare, we’d like to clear up some confusion and concerns about our new opioid policies:

1. You and your doctor decide whether you reduce or stop using opioids, not Medicare

Each person’s situation is different, so you and your doctor should decide when to start, stop or cut down on using prescription opioids. Managing pain is critical for patients, and changing pain-management strategies can be challenging, especially after a long time on high dosages.

2. Medicare’s new opioid policies generally don’t apply to people with cancer, people receiving hospice, palliative or end-of-life care, and people in a long-term care facility

The new policies are tailored to address the specific needs of people with Medicare who take opioid medications.

3. You may be limited to an initial seven-day supply if you haven’t filled an opioid prescription recently, or if it’s the first time you’re prescribed opioids. This limit doesn’t apply if you’re already taking opioids

If you’re new to taking opioids and your prescription is for longer than seven days, you can either receive up to a seven-day supply from the pharmacy, or you or your doctor can ask your Medicare prescription-drug plan to cover the full supply.

4. If you don’t think the policy should apply to you, you or your doctor can ask for a coverage decision from your Medicare prescription-drug plan, including an exception. If you disagree with the plan’s decision, you can appeal

Visit Medicare.gov to learn about the appeals process and Medicare drug plan coverage rules, or call us at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Read your Medicare drug plan’s materials to learn about their specific drug coverage rules.

Kimberly Brandt, Principal Deputy Administrator for Operations, Centers for Medicare & Medicaid Services, [email protected]

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