Granite Alliance is commited to help combat the opioid epidemic. We recognize that opioids are commonly prescribed to Medicare members suffering from chronic pain and physical illness. We want to ensure that you are being treated properly and should consider the following when discussing treatment options with your physician.
Opioids are a group of pain-relieving medications that are available by prescription. Examples of common opioids include oxycodone (OxyContin®), hydrocodone, (Vicodin®), codeine, morphine, and many others. They treat moderate to severe pain that may not respond well to other pain drugs. The ingredients in opioids drive up levels of feel-good hormones. So, they are considered highly addictive, and they should be used with caution. When taken correctly (as prescribed by your doctor as part of your treatment), opioid medications help manage pain safely and effectively. However, misusing prescription opioid medications can put you at risk of dependence and addiction.
Anyone taking opioids can become addicted and is at risk of an accidental overdose or death. If your doctor prescribes an opioid, ask for the lowest dose possible and only take it for as long as necessary. Ask your doctor about possible withdrawal symptoms if you must take opioids for longer than several days. With your doctor, review the side effects of opioids so you know what to expect, and discuss when it’s time to stop the medication. Be sure to tell your doctor about any other medications you’re taking, especially those that cause drowsiness. Avoid combining the opioid with alcohol as this can increase your risk of an overdose or side effects. Continue to re-evaluate your pain with your doctor and explore alternative pain treatment options that do not involve prescription drugs.
You can also avoid opioid misuse by:
You should always tell your doctor and pharmacist about all the medications you are taking. There’s always a risk of increased side effects when you combine medications. Opioids can make you sleepy. If you take them with other medications that cause drowsiness it can increase these effects. This can lead to slowed breathing, decreased heart rate and a risk of death. It’s recommended by the Centers for Disease Control and Prevention (CDC) that you avoid taking benzodiazepines while taking opioids. Benzodiazepines are drugs prescribed to sedate, prevent seizures, and relieve anxiety. You should never stop taking a medication without first talking with your doctor or pharmacist.
We have a program that can help make sure our members safely use high-risk medications such as prescription opioids and benzodiazepines. This program is called a Drug Management Program (DMP). If you use opioid medications that you get from several doctors or pharmacies, we may talk to your doctors to make sure your use of opioid medications is appropriate and medically necessary. Working with your doctors, if we decide your use of prescription opioid or benzodiazepine medications is not safe, we may limit how you can get those medications. The limitations may be:
If we think that one or more of these limitations should apply to you, we will send you a letter in advance. The letter will have information explaining the limitations we think should apply to you. You will also have an opportunity to tell us which doctors or pharmacies you prefer to use, and about any other information you think is important for us to know. After you’ve had the opportunity to respond, if we decide to limit your coverage for these medications, we will send you another letter confirming the limitation. If you think we made a mistake or disagree with our determination that you are at-risk for prescription drug misuse or with the limitation, you and your prescriber have the right to ask us for an appeal. You must make your appeal request within 60 calendar days from the date on the letter. If you choose to appeal, we will review your case and give you a decision within 7 calendar days, or within 72 hours if you, your doctor, or your prescriber indicate that your health requires it. If we continue to deny any part of your request related to the limitations that apply to your access to medications, we will automatically send your case to an independent reviewer outside of our plan.
The Drug Management Program may not apply to you if you have certain medical conditions, such as cancer, you are receiving hospice, palliative, or end-of-life care, or live in a long-term care facility.
Last Updated Date: 01/01/2024
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