Colorado’s Medicaid program is reducing the amount of opioid painkillers it allows its recipients to receive, part of a growing campaign to restrict how many of the highly addictive drugs are in circulation.
The new policy, announced this month, will roll out in two phases. The first, which goes into place in August, applies to Medicaid recipients who are prescribed opioids for the first time in at least a year. The policy will limit those patients to receiving only a seven-day supply to start, with two additional one-week refills possible if the patient requests them. Another refill request beyond that will require additional scrutiny.
Dr. Judy Zerzan, the chief medical officer for Colorado’s Department of Health Care Policy and Financing, which administers Medicaid in the state, said the goal of this first phase is to prevent new patients from becoming hooked on pain pills.
The second phase will reduce the total dosage of opioids that all Medicaid patients can receive.
Currently, Medicaid won’t pay for recipients to receive more than 300 morphine milligram equivalents, or MME, per day. The MME measurement helps doctors standardized doses across opioids of varying potency.
The new policy will reduce that maximum amount to 250 MME per day. Zerzan said the state will also likely look at reducing that limit further but wants to ensure that patients currently on a high dose are weaned down slowly to avoid pain spikes or problems from withdrawal.
The amount is still well above federal guidelines put in place last year. The Centers for Disease Control and Prevention warn doctors about prescribing opioid doses above 90 MME per day. Colorado’s medical regulators have encouraged all doctors to keep prescriptions below 120 MME per day.
But chronic pain patients in Colorado and other states have said such limitations block access to important medications they need to live normal lives. And the new Medicaid policies will have exemptions for people receiving hospice or palliative care or who are cancer patients.
Marc Williams, a spokesman for the program, said doctors can also call a Medicaid specialist if they believe other patients require more than 250 MME per day.
“Every patient has individual medical needs,” he said, “and they’ll be evaluated on a case-by-case basis.”
Zerzan said medical research shows opioids may reach maximum efficacy for even the most severe pain at dosages as low as 90 MME, and she said the state will encourage doctors to pursue alternate medications or pain-management practices to try to prevent patients with chronic pain from developing a tolerance to opioids that requires higher amounts. Colorado’s Medicaid program two years ago increased how much it pays for outpatient physical therapy, in part to encourage its use more widely for pain management.
Zerzan said she hopes the new policy will also reduce overdoses and deaths. When researchers analyzed the state’s Medicaid data, she said, they found patients were more likely to overdose if they were prescribed over 300 MME per day.
“There was definitely a trend,” she said, “that the more opiates you were on, the greater your risk of death.”
Medicaid, which is a shared state and federal program for people with low incomes or disabilities, covers more than one out of every five people in Colorado. Williams said, as of late last year, there were 200 Medicaid members in the state receiving 300 MME per day or more.
