Drug Management Program (DMP) and Opioids

Switch to:

Drug Management Program (DMP) and Opioids

drug management program header

Drug Management Program (DMP) and Opioids

To address our nation’s ongoing opioid epidemic, we are committed to promoting safe and responsible pain management. Our Drug Management Program (DMP) helps our Medicare members safely use their prescription opioid medicines or other medicines that are frequently abused.

Working with your doctors, we can help determine if you are at risk for misusing or abusing opioids—pain medications like hydrocodone (e.g., Vicodin) or oxycodone (e.g., Oxycontin, Percocet) or benzodiazepines (antianxiety medicines like Klonopin) —and may limit how you can get those prescriptions.*

Limitations may include:

  • Requiring you to get all your opioid or benzodiazepine prescriptions filled from one pharmacy.
  • Requiring you to get all your opioid or benzodiazepine medicines from one doctor.
  • Limiting the amount of opioid or benzodiazepine medicines we will cover for you.

These risks increase as your dosage increases, if you take them for a long period, even if you take them as prescribed. Your risks also increase if you get opioids from multiple doctors and pharmacies or take them in combination with other prescription drugs used for anxiety or sleep. Taking more than the required dose can create a dependency (i.e., the more you take, the more your body relies on the medicine to address your discomfort).

 

If we decide 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 terms of 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. If you think we made a mistake or you disagree with our determination, you have the right to ask us for an appeal. See Chapter 9 in your Evidence of Coverage (EOC) for information about how to ask for an appeal.

 

*The DMP may not apply to you if you have certain medical conditions, such as cancer, a sickle cell diagnosis, or you are receiving hospice care or live in a long-term care facility.

  • Keep active communication with your doctor regarding your opioid prescriptions, side effects, and pain levels.
  • If you feel you are becoming addicted to your pain medicine, notify your doctor immediately.
  • Together with your doctor, explore other options to treat pain, such as:

1. Acetaminophen – the active ingredient in Tylenol. Although acetaminophen isn’t an anti-inflammatory, it is good at relieving mild-moderate pain such as headaches, back pain, fevers, and arthritis.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs) – the active ingredient in ibuprofen, naproxen, and aspirin (brands like Advil and Motrin). These medicines relieve mild to moderate pain and can reduce swelling and inflammation.

3. Antidepressants – Even at low doses, antidepressants can relieve mild-moderate chronic pain and nerve pain (shooting and burning sensation) caused by damaged nerves.

  • Consider non-drug options to reduce pain. Examples include:
    • Physical therapy
    • Acupuncture
    • Chiropractic therapy
    • Cognitive behavioral therapy
    • Massage

 

Note: The above examples may not be covered by all plans. Check your benefits to confirm coverage.

 

Unused prescription drugs should be disposed of as soon as possible if they are no longer needed. Timely disposal of unused medicines can reduce the risk of others taking the medicine accidentally or intentionally misusing it. Flushing it or dumping down a drain is not a good way to dispose of prescription medicine because it can end up in local lakes and rivers.

Here are some great ways to discard medicine you no longer need:

  • Drug “Take-Back” Programs – Take-back programs allow the public to bring unused drugs to a central location for proper disposal. This is the best and most environmentally friendly way to dispose of your prescription medicine. The U.S. Drug Enforcement Agency (DEA) periodically provides drug disposal sites in communities across the nation. The DEA also has permanent drug disposal sites in certain pharmacies or hospitals. To find location in your specific area call the DEA’s Registration Call Center at 800–882–9539, or visit the National Association of Boards of Pharmacy (NABP)’s locator. You can also visit the DEA’s disposal information site to learn more.
  • Disposal in Household Trash – If the above programs are not available in your area, place the drugs in the trash by following these steps:

1. Remove them from their original containers. Conceal or remove any personal information, including the Rx number.

2. Mix the medicines with something inedible, such as coffee grounds or kitty litter.

3. Place the empty container and mixture in a sealed bag or empty can.

4. Scratch out all the personal information on the prescription label.

5. Throw the container in your household trash.

 

Additional resources:
How to Safely Dispose of Drugs
Tips for Safe Storage and Disposal

Medicare Pharmacy

Additional Information

Learn more about what our over-the-counter debit card covers, how to get money back for a drug, and more.

Pharmacist smiling at male customer.

Last Updated 6/24/2022

Y0026_201700_C