Medicare AdvantageCoverageMedium impact
CMS guideline change – opioids
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
CMS implemented a hard safety edit for Medicare Advantage members limiting opioid prescriptions to a maximum 7-day supply at pharmacy point-of-sale for opioid-naive patients (no opioid prescription in previous 90 days). Prescriptions written for longer durations will be rejected at the pharmacy, though pharmacies can dispense up to 7 days.
Action Required
Effective immediately: Providers must limit opioid prescriptions to 7 days or less for Medicare Advantage patients who haven't had an opioid prescription in the previous 90 days. Update prescription protocols and inform providers that longer prescriptions will be rejected at pharmacy point-of-sale. Educate clinical staff on the 90-day lookback period for opioid-naive determination.