Some of the most commonly treated symptoms—pain, anxiety, and sleep issues—can carry hidden risks. These conditions are often managed with medications like opioids and benzodiazepines, which may be appropriate individually but dangerous when prescribed together over time.
That danger isn’t always visible. Overlapping use can lead to respiratory depression, sedation, falls, cognitive decline, or overdose, especially in older adults or patients receiving care from multiple providers.
To reduce avoidable harm, the Centers for Medicare & Medicaid Services (CMS) introduced a new Medicare Part D Star Ratings measure that went into effect January 1, 2025: Concurrent Use of Opioids and Benzodiazepines (COB). This measure underscores the importance of safer prescribing practices and gives providers a clear path to reduce risk.
What the New Measure Tracks
Concurrent Use of Opioids and Benzodiazepines (COB):
- Applies to Medicare Advantage and Part D beneficiaries age 18+
- Flags patients who receive two or more opioid prescriptions (filled on different days) totaling at least 15 days within the measurement year and who concurrently fill benzodiazepine prescriptions totaling 30 or more cumulative overlapping days
- Excludes patients with cancer, hospice/palliative care, or sickle cell disease
(Source: PQA Alliance)
Understanding the Risk
When a patient is prescribed both an opioid (for at least 15 days) and a benzodiazepine (for at least 30 cumulative days), CMS classifies them under the COB safety measure. This threshold isn’t arbitrary—it’s based on evidence showing increased harm after extended overlapping use.
Some patients may not fit the stereotypical image of high-risk. They may be older adults managing chronic back pain and insomnia, or individuals with a history of anxiety now dealing with post-operative recovery. These patients don’t always raise red flags, but they are precisely the ones who may be at silent and serious risk.
Why This Matters to You
This measure impacts your quality performance, particularly if you treat Medicare or dual-eligible patients. More importantly, it’s a clinical safety issue: even when prescriptions originate from different providers, the risk to the patient is cumulative.
What You Can Do Now
Flag Overlaps Early
- Use EHR or pharmacy data to identify patients with overlapping prescriptions
- Monitor those approaching or exceeding 30 cumulative days
Coordinate Across Providers
- Communicate with co-prescribers to align care
- Address unintentional polypharmacy before harm occurs
Taper When Appropriate
- Consider gradual benzodiazepine reduction plans
- Document clinical rationale and monitor progress
Consider Safer Alternatives
- Non-benzodiazepine options for anxiety
- Non-opioid treatments for pain when feasible
Talk With Patients Openly
“These two medications work on the same part of the brain. Over time, that can impact breathing and alertness. Let’s look at safer ways to help you feel better.”
The Bottom Line
This isn’t just about scores—it’s about catching silent risks before they cause real harm. With early identification, provider coordination, and safer prescribing strategies, you can lead meaningful change.
With axialHealthcare’s guidance and risk management tools, you don’t have to navigate this alone. Together, we can reduce risk, improve safety, and protect what matters most: your patients.