Opioids - frequently asked questions

This type of medication is generally used for the treatment of pain.

Is it safe to take opioid medications?

Opioid medications can be used to help with short- and long-term pain. However, extended use of opioids can cause serious risks that you and your doctor should discuss and monitor closely. It is very important that you understand why you are being prescribed opioid(s).

What are the risks of taking opioids for a long time?

• Tolerance – Over time, you may need higher doses to relieve your pain.
• Dependence – You may have withdrawal symptoms when you stop taking opioids. This can happen after taking them for less than a week.
• Addiction – You may not be able to control your opioid use.
• Overdose or death

How do I safely take opioid medications?

• Always follow your doctor’s directions and never share your medications with others.
• Don’t take your medication more often than prescribed. Talk to your doctor or pharmacist before you take any extra doses.
• Stay away from dangerous drug interactions. Talk to your doctor or pharmacist about all the drugs you take. Mixing opioids with any of the following can greatly add to the risk of overdose:
• alcohol
• sleeping pills (such as zolpidem (Ambien^®) or zaleplon (Sonata^®))
• anxiety drugs (such as diazepam (Valium^®), alprazolam (Xanax^®), and lorazepam (Ativan^®))
• If your pain is under control, ask your doctor if you should take them less often or change to other pain relief options.
• For safety reasons, unused medications should be disposed of as soon as possible. Talk to your pharmacist for safe drug disposal options in your area.

What alternative pain management options should I consider?

Talk to your doctor about ways to manage your pain that do not involve prescription opioids. Some of these options may work better and have fewer risks and side effects. Depending on the type of pain you are experiencing, options* may include:

• Over-the-counter medications such as ibuprofen (Motrin^®), acetaminophen (Tylenol^®) or naproxen (Aleve^®).
• Prescription-strength anti-inflammatory medications such as celecoxib (Celebrex^®), diclofenac (Voltaren^®), and etodolac (Lodine^®).
• Some prescription non-opioid medications that target pain-producing nerves, such as gabapentin (Neurontin^®) and pregabalin (Lyrica^®).
• Injectable and topical therapies.
• Chiropractor services, physical and other therapies, heat or cold compresses, exercise, acupuncture, and cognitive behavioral therapy.

* Options listed above may not be covered on all plans or may require prior authorization.

What is naloxone and is it safe to use?

Opioids can sometimes slow or even stop your breathing. This can happen if your body can’t handle the amount of opioids that you take that day. Naloxone is a medication that can undo the effect of opioids in your body. Naloxone is safe and can save your life. Talk to your doctor or pharmacist to see if it should be prescribed to you and how to use it correctly. In some states, naloxone can be purchased in the pharmacy without a prescription from a physician.

What opioid treatment services are available?

Medicare covers Opioid Treatment Programs (OTPs) for opioid use disorder (OUD) treatment. Services are provided to people with Medicare Part B (Medical Insurance). For information on your plan’s benefits related to treatment for prescription drug misuse, including medication assisted treatment, behavioral health, and counseling services, call us at the phone number on the back of your ID card.

What happens at the pharmacy?

There are several opioid safety edits in place to ensure safe use of opioids. A safety edit is a type of alert that come up on a pharmacy's computer system.

Fallon has implemented opioid safety edits that occur when a member fills a prescription at a pharmacy. The edits are used to identify members that may be at risk for opioid overuse.

These edits require resolution. The pharmacist at the pharmacy may override some of the edits with appropriate codes, may need to consult with the provider, and may need to inform the provider that a prior authorization is required. Since these are safety edits, they will still apply during a member’s transition period; meaning, the claims will still reject with the edits and require resolution. Buprenorphine for medication-assisted treatment (MAT) is not included in the safety edits. Hospice/palliative care, active cancer-related pain, sickle cell disease, and LTC members are excluded from the safety edits.

Members have the right to request a coverage determination when a prescription cannot be filled at the pharmacy as written.