January 27, 2026

To promote safe medication, use in older adults, new prior authorization criteria targeting specific benzodiazepines has taken effect. This letter provides information about the concurrent use of opioids measure and outlines changes that may affect prescribing practices.

In CY2026, prior authorization is required for patients aged 65 and older who are on an existing opioid prescription and are prescribed any of the specified benzodiazepines concurrently for 15 or more days’ supply.

The Concurrent Use of Opioids and Benzodiazepines (COB) Measure is in place to monitor performance on the percentage of Medicare patients ages 18 years and older who have concurrent use of opioids and benzodiazepines for 30 or more cumulative days. Due to the risk of sedation, respiratory depression, coma, and death and the goal to improve performance on the measure:

Requirements

The required medical information is listed below for all three medication targets for all indications:

1. Chart notes documenting the patient’s diagnosis.
2. Chart notes documenting an explanation showing the benefit outweighs the potential risk for the use of the high-risk medication with concurrent opioid therapy for the risk versus benefit profile. 
3. Prescriber provides attestation of intent to monitor and address treatment-related adverse events. 

For diazepam and lorazepam for anxiety disorders:

Using concurrently with an SSRI or SNRI until the SSRI/SNRI becomes effective for the symptoms of anxiety, OR the patient has experienced an inadequate treatment response, intolerance, or has a contraindication to at least one agent from SSRI and SNRI. 

For temazepam and lorazepam for insomnia:

Inadequate response, intolerance, or has a contraindication to two safer alternatives, such as trazodone, mirtazapine, doxepin 3mg or 6mg, or ramelteon

For diazepam for muscle spasms:

Documentation of inadequate response, intolerance, or contraindication to at least two non-high risk formulary alternatives, such as tizanidine tablet, baclofen, dantrolene, or methocarbamol 500mg or 750mg.

For any inquiries, please contact our Pharmacy Department at 215-991-4300, available Monday through Friday 8:00 a.m. to 6:00 p.m. or the Provider Services Helpline at 1-888-991-9023, available Monday through Friday from 9:00 a.m. to 4:30 p.m.