Opioid Prescription Rules

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

1. 7-day Supply Limit

When you start a new opioid medication, you’ll be limited to a 7-day supply. This rule doesn’t apply to you if any of the following are true:

• You’re getting active cancer treatment
• You're a cancer survivor with chronic pain after completing cancer treatment, in clinical remission, or under cancer surveillance (Starting on January 1, 2025)
• You have sickle cell disease
• You’re a long-term care (LTC) resident
• You’re receiving hospice, palliative, or end-of-life care
• You’re getting Buprenorphine for medication-assisted treatment of opioid use disorder

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 cancer survivor with chronic pain after completing cancer treatment, in clinical remission, or under cancer surveillance (Starting on January 1, 2025)
• You have sickle cell disease
• You’re a long-term care (LTC) resident
• You’re receiving hospice, palliative, or end-of-life 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).

That's because when you take both types of medicine at the same time, you're more likely to have 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 causes 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 1-855-344-0930, TTY 711.