The Concurrent Benzodiazepine and Opioid Use (COB) is a Part D Star Measure introduced by the Centers for Medicare and Medicaid Services to ensure safe medication coordination and usage among Medicare patients.
The measure focuses on identifying potentially unsafe medication overlap, where higher percentages reflect increased patient safety risk and poorer STARS performance.
Medicare patients 18 years and older who meet the following criteria during the measurement year are part of the measure population:
Has two or more opioid prescriptions filled on different dates
Has a cumulative supply of opioids for 15 days or more
Medicare patients 18 years and older who are in the denominator and meet the following criteria during the measurement year then move to the numerator and fail the measure:
Has prescriptions filled for two or more benzodiazepines filled on different dates
Has a cumulative supply of opioids and benzodiazepines for 30 days or more
Medicare patients are excluded from this measure if they have any of the following conditions documented:
Cancer diagnosis
Sickle-cell disease
Hospice or palliative care
The CDC Opioid Prescribing Guideline strongly recommends that providers exercise caution when prescribing opioids concurrently with other central nervous system depressants such as benzodiazepines.
Concurrent benzodiazepine and opioid use is associated with greater risk for accidents (e.g., falls and fractures, motor vehicle crashes), profound sedation, respiratory depression, overdose, and death, especially when prescribed by multiple providers.
When meeting with your Medicare patients, educate them about the risks and side effects of both opioids and benzodiazepines.
If the risks outweigh the benefits, consider tapering them off the drugs gradually and transitioning them to a alternative medication when possible. If the benefits outweigh the risks, consider instituting controlled substance treatment agreements with your patient.
Always review the Prescription Drug Monitoring Program data for your area for controlled substances each time you write or refill a prescription for an opioid or a benzodiazepine, even if with established patients.
This database will tell you whether patients are being prescribed controlled substances by other providers and allows you to see if new medications have been added at any time.
Oftentimes patients are prescribed different medications from multiple providers. By asking your patients about their current medications, including ones they’re being prescribed from other providers, you will have a full picture of your patients’ medication regimen and can ensure proper medication management.
Assessing your patients' medications for both their indication and duration at each visit is also important in proper medication management. CMS has five central principles for providers to follow when co-prescribing benzodiazepines and opioids.
If you want to learn more about the COB safety measure and how to support your Medicare patients, please reach out to your regional representative.