The Floodgates of Grief

When a pain so horrific, so deep and so devastating happens to you

You are ripped apart, torn inside out

And if you’ve had other deep heartaches and pain in your life

And if you have never fully acknowledged those hurts

Never gave them a voice and claimed them as your own

If you covered them over with pretty bandages and pretended they were healed

Be prepared for them to come to the surface again, screaming to be heard…

The future of pain patients in Medicare

A centerpiece of our strategy to reduce the inappropriate use of opioid analgesics in Part D is the adoption of a policy and guidance by CMS by which Part D sponsors identify Part D enrollees who have potential opioid or acetaminophen overutilization that may present a serious threat to patient safety. Acetaminophen is included in this strategy because it is manufactured in combination with many opioids, and unlike opioids has an FDA-approved maximum daily dose. Overutilization of opioids or acetaminophen products can result in serious adverse events including death.

To strengthen CMS’s monitoring of Part D plan sponsors’ drug utilization management programs to prevent overutilization of these medications, the Medicare Part D Overutilization Monitoring System (OMS) was implemented in 2013. Through this system, CMS provides quarterly reports to sponsors on beneficiaries with potential opioid or acetaminophen overutilization identified through analyses of Prescription Drug Event (PDE) data and through beneficiaries referred by the CMS Center for Program Integrity (CPI). Sponsors are expected to utilize various drug utilization monitoring (DUM) tools, including: formulary-level controls at point of sale (such as safety edits and quantity limits); a review of previous claim and clinical activity to identify at-risk beneficiaries, case management outreach to beneficiaries’ prescribers and pharmacies, and beneficiary-level point of sale claim edits, if necessary to prevent continued overutilization of opioids.

Lastly, sponsors that have concluded such point of sale edits are appropriate are expected to share information with a new sponsor when the beneficiary moves to another plan in accordance with applicable law…

One proposal to prevent prescription drug abuse in Medicare Part D would give the Secretary of Health and Human Services (HHS) the authority to establish a program that would require that high-risk Medicare beneficiaries only utilize certain prescribers and/or pharmacies to obtain controlled substance prescriptions, similar to many State Medicaid programs…

Many State Medicaid Agencies have started using a variety of approaches to prevent prescription drug abuse… States are also using pharmacy management review and restriction programs which confine patients with high-utilization of prescription pain medication to a single provider and pharmacy…

Just a lot of big words and fancy talk saying the same things that the DEA says… We must prevent abuse and addiction whenever we can, and if that includes identifying, monitoring, shaming, and criminalizing pain patients, well, tough noogies.

Does CMS have a similar program for identifying and monitoring other patients, like diabetics and heart attack patients?  Those who suffer from dementia and Alzheimer’s?  Do none of those patients abuse and overdose on their medications?  And while CMS spends all this time, money and effort to do the same things the DEA is doing, what other public health areas are left unattended?

Once these polices are put in place by Medicare, that’s the end of the story for pain patients. Once Medicare adopts regulations, then all the other insurance companies follow suit.  Although really, it looks like it’s already too late.  The DEA’s war against pain patients has won — I really don’t know what it would take, at this point, to turn things around.

If the government put as much time, money and effort into treating pain as it does into the drug war, all these problems would be smaller and easier to manage.  The government… always trying to fix problems that it created…