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CMS Proposes Opioid Prescribing Limits for Medicare Enrollees
New regulations recently proposed by the Centers for Medicare & Medicaid Services (CMS) would put limits on pharmacies’ filling of opioid prescriptions for Medicare beneficiaries.
Under the proposal, Part D plans would implement “hard formulary levels” at pharmacies. This formulary would restrict the amount of opioids that could be received by beneficiaries.
“We are proposing important new actions to reduce seniors’ risk of being addicted to or overdoing it on opioids while still having access to important treatment options,” said Demetrios Kouzoukas, CMS deputy administrator and director of the Center for Medicare, during a recent conference call. “We believe these actions will reduce the oversupply of opioids in our communities. These are triggers ... [that] can prompt conversations between physicians, patients, and plans about appropriate opioid use and prescribing. The trigger can only be overridden by the plan sponsor after efforts to consult with the prescribing physician.”
The safety level would be a 90 morphine-mg equivalent with a seven-day supply allowance and the proposal would limit the number of pills in an initial prescription for acute pain, “possibly with or without a daily dose maximum,” according to Kouzoukas. Comments on the proposals were accepted by CMS through March 5. Visit www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovcontra/rxutilization.html for more information.
National Health Spending Reached $3.5 Trillion in 2017
Officials from the Centers for Medicare & Medicaid Services (CMS) have reported that national health spending grew by an estimated 4.6% in 2017, up to $3.5 trillion. The number represents a 4.3% increase of the growth rate in 2016. According to a report by MedPage Today, the projected increase was due in part to increased growth in Medicare spending and higher premiums for health insurance bought through the Affordable Care Act’s marketplaces. National health spending is expected to increase 5.5% annually over the next decade (1% faster than the increase in the gross domestic product during that period), reaching a total of $5.7 trillion by 2026, according to the report.
Also of note, spending on physician and clinical services grew by an estimated 5% in 2017 to $698.3 billion, a decline from 5.4% in 2016. The proliferation of high-deductible health plans, which encourage less spending on healthcare, will have contributed to that deceleration, according to the report.
Additionally, healthcare’s share of the gross domestic product is expected to rise from 17.9% in 2016 to 19.7% by 2026 while the health spending and enrollment growth during this time will largely be driven by fundamental economic and demographic factors — projected income growth, increased prices for medical goods and services, and increasing enrollment in Medicare due to the aging of the population. By 2026, federal, state, and local governments are projected to sponsor 47% of national health spending, up from 45% in 2016, the reported stated. Medicare growth is expected to increase in the 2021-26 period in terms of payments to physicians and clinics, in part related to incentive payments for Medicare Access and CHIP Reauthorization Act legislation. A study by CMS
officials has also been published by Health Affairs.
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