CVS Health Moves to Limit Access to Opioid Painkillers
September 21 2017 - 5:59AM
Dow Jones News
By Jeanne Whalen
One of the largest managers of pharmaceutical benefits in the
U.S. says it will start limiting the duration and dose of some
prescriptions for opioid painkillers, in an effort to combat
widespread addiction.
CVS Health Corp., which administers drug benefits for employers,
insurers and some state Medicaid programs, said it would limit
opioid prescriptions to seven days or less for certain patients
with acute pain who haven't previously taken an opioid painkiller.
That will be a big change, given that many CVS-covered patients
with acute pain receive opioid prescriptions for 20 days or more,
Troyen Brennan, CVS's chief medical officer, said in an
interview.
CVS will also limit patients with chronic pain to a maximum
daily dose of 90 morphine milligram equivalents, or MMEs, a
standard unit of measure in pain medicine, Dr. Brennan said.
CVS said it based the limits on Centers for Disease Control and
Prevention recommendations published last year, though one
addiction expert said even stricter limits would better reflect CDC
advice.
Starting in February 2018, if CVS-covered patients arrive at the
pharmacy with a prescription above the new limits, the pharmacy
will kick it back to the doctor for review, Dr. Brennan said.
CVS manages medications for nearly 90 million people, or about
28% of the U.S. population, through its Caremark unit. It also runs
9,700 retail pharmacies nationwide.
There will be ways around the rules -- doctors will be able to
appeal the limits, and employers and insurers will be able to opt
out of the limits if they don't want them to apply to their
patients, though CVS said it didn't anticipate many would opt
out.
The "overarching reason" for the limits "is to reduce the amount
of human suffering that results from people being addicted to these
medications," Dr. Brennan said. The new rules could also bring cost
savings for employers and insurers if they prevent some patients
from becoming addicted, he said.
Widespread opioid addiction has pushed U.S. overdose death rates
to new highs. Many Americans became addicted by taking prescription
painkillers, and often progressed to heroin and other street
drugs.
CVS and other health-care companies have faced accusations of
helping fuel the crisis through their handling of opioid
painkillers. Last year, CVS paid $3.5 million to settle federal
allegations that 50 of its pharmacies in Massachusetts and New
Hampshire filled forged prescriptions for painkillers and other
controlled substances. The company said it has "implemented
enhanced policies" to help its pharmacists determine whether
prescriptions are legitimate.
Earlier this year, the Cherokee Nation sued drug distributors
and pharmacy chains including CVS in a tribal court in Tahlequah,
Okla., alleging they "utterly failed" to control a flood of
painkillers that caused widespread addiction in the tribal
community. CVS officials Wednesday called the lawsuit
groundless.
Gary Mendell, founder of a nonprofit called Shatterproof that
seeks to combat addiction, welcomed CVS's efforts to restrict
prescriptions but said the firm should set even stricter limits if
it wants to follow CDC guidance.
The CDC recommendations advise doctors that prescriptions of
"three days or less" are often sufficient for patients with acute
pain, and that more than seven days "will rarely be needed." For
chronic pain patients, they advise doctors to "carefully reassess"
the need for doses of 50 MMEs or more a day, and to "avoid" doses
of 90 MME or more a day.
The CVS limits are "at the upper range of the CDC guidelines,"
Mr. Mendell said.
A dose of 50 MME is equal to 33 milligrams of oxycodone, a
common opioid painkiller, according to the CDC. Ninety MME equals
60 milligrams of oxycodone.
Write to Jeanne Whalen at jeanne.whalen@wsj.com
(END) Dow Jones Newswires
September 21, 2017 05:44 ET (09:44 GMT)
Copyright (c) 2017 Dow Jones & Company, Inc.
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