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Alternative Pain Management Therapies to Opioids

Opioids are powerful medications that can reduce severe pain in chronic conditions to a manageable level. However, prolonged intake of opioids can also lead to dependence, addiction, tolerance, and other side effects such as constipation, drowsiness, and shortness of breath.

It is important to consider other alternatives to chronic opioid pain management, especially in non-cancer pain. Talk to your doctor or other health care professional about non-opioid pain management options that may be right for you.

Over-the-counter products are typically not covered under Medicare Advantage plans. Some products may be covered under the Medicaid benefit.

Over-the-Counter Medications

Oral

  • Acetaminophen (Tylenol)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Naprosyn)
  • Aspirin

Topical

  • Diclofenac sodium topical gel 1% (Voltaren)
  • Capsaicin cream/gel
  • Menthol/Camphor patch (Icy Hot, Biofreeze)

Prescription medications below are covered with any applicable co-pay or deductibles unless otherwise indicated. Additional coverage requirements are indicated in parathesis (QL, PA, ST) below.  Coverage during the benefit year is subject to change. Click here to review your benefit plan’s drug formulary to determine updated and detailed coverage criteria, including drug tiers as applicable to your plan benefit.

Prescription Medications

Oral

  • Gabapentin or Pregabalin
  • Venlafaxine or Duloxetine
  • Celecoxib, Diclofenac, Indomethacin, Ketorolac, Etodolac er, Ibuprofen, Naproxen, Meloxicam, Naproxen
  • Butalbital-apap-caffeine

Topical

  • Lidocaine patch (PA)/ external solution (QL)/ cream (QL)
  • Diclofenac gel/ solution

PA: Prior Authorization – You (or your physician) are required to get prior authorization before you fill your prescription for this drug. Without prior approval, we may not cover this drug.

QL: Quantity Limit – There is a limit on the amount of this drug that is covered per prescription, or within a specific time frame.

ST: Step Therapy – In some cases, you may be required to first try certain drugs to treat your medical condition before we will cover another drug for that condition.

To determine your plan coverage for these treatment options, please refer to your Evidence of Coverage (EOC) or contact AgeWell New York at 1-866-237-3210 (TTY/TDD 1-800-662-1220), Monday – Sunday 8:00 am – 8:00 pm. Depending on your plan, AgeWell New York may provide additional acupuncture treatments in conjunction with Original Medicare coverage. We will also authorize PT/OT and chiropractic interventions. 

Non-Pharmacologic Treatment Options

  • Cognitive Behavioral Therapy (prior authorization may be required)
  • Exercise
  • Heat Therapy
  • Occupational Therapy (OT) or Physical Rehabilitation Therapy (PT) (prior authorization may be required)
  • Acupuncture (up to 12 visits in 90 days with the possibility of additional visits under eligibility criteria)
  • Massage Therapy
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Chiropractic Services (plan covers manual manipulation of the spine to correct subluxation)

 

References

  1. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects. Pain Physician. 2008 Mar;11(2 Suppl): S105-20. PMID: 18443635.