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New Opioid Prescription Rules


To help address the opioid crisis, the Centers of Medicare and Medicaid Services (CMS) have created new rules for opioid prescriptions. The goal is to keep you safe, while making sure you still have access to the drugs you need.

Starting January 1, 2019, we’ll put into place the following rules from CMS.

1. 7-day Supply Limit

When you start a new opioid medication, you’ll be limited to a 7-day supply. The pharmacist can’t override this limit, and you can’t get a transition fill* as a workaround.

  • You’re getting active cancer treatment
  • You’re a long-term care (LTC) resident
  • You’re receiving hospice or palliative care
  • You’re getting Buprenorphine for medication-assisted treatment of opioid use disorder

*A transition fill is a one-time, 30-day supply of a medication. You would typically get one when you switch health plans and a drug you’re already taking isn’t covered by your new plan.

2. Pharmacist Review for High-Dose Opioids

To help prevent opioid overdoses and misuse, your pharmacist will need to review prescriptions for high-dose opioids. Anything over 90 morphine milligram equivalents per day (90 MME/day) is high dose*.

This rule doesn’t apply to you if any of the following are true:

  • You’re getting active cancer treatment
  • You’re a long-term care (LTC) resident
  • You’re receiving hospice or palliative care
  • You’re getting Buprenorphine for medication-assisted treatment of opioid use disorder  

*Different opioid drugs have different strengths. For example, a 10 mg dose of codeine isn’t as potent as a 10 mg dose of oxycodone. Doctors came up with “morphine milligram equivalent” as a way to safely compare opioid medications. This isn’t something you’ll need to use — your pharmacist or doctor will look into it for you.   

3. Pharmacist Review for Opioids and Benzodiazepines

Your pharmacist will need to review your opioid prescription if you’re also taking a benzodiazepine, like diazepam (Valium) or alprazolam (Xanax).

Taking too much of both types of medicine at the same time can cause serious side effects, such as slowed breathing, low blood pressure, extreme tiredness, coma, overdose, and death.

4. Pharmacist Review for Long-Acting Opioids

If you try to fill more than one prescription for long-acting opioids, your pharmacist will need to review it. Taking too much opioid medication can cause serious side effects, such as slowed breathing, low blood pressure, extreme tiredness, coma, overdose, and death.

Can't get the medication you need?

If so — and you think these rules shouldn’t apply to you — call us at 1-800-DEVOTED (1-800-338-6833), TTY 711.

Providers: To ask for an exception for one of your patients, please call 1-800-990-0723, TTY 711.