September 22, 2017

CVS unveils sweeping initiative to curb opioid misuse

Daily Briefing

    To combat the opioid epidemic, CVS Health on Thursday announced that it will restrict the dose and duration of certain opioid prescriptions.

    Your top resources for combatting the opioid epidemic in one place

    Background

    The announcement comes as several large insurers and pharmacy benefit managers move to curb opioid misuse, USA Today reports. For instance, Anthem last month said it met its goal of cutting the number of prescribed opioids filled at pharmacies by 30 percent over the last five years, and Express Scripts earlier this month expanded a pilot program aimed at curbing opioid misuse.

    According to the Wall Street Journal, CVS's Caremark unit is one of the larges pharmacy benefit managers in the United States. It manages the prescriptions of nearly 90 million U.S. residents, or about 28 percent of the U.S. population, with more than 1,000 walk-in clinics and about 9,700 retail pharmacies.

    Details on initiative

    CVS said beginning in February, it will limit opioid prescriptions for patients in acute pain who have not previously been prescribed opioids to seven days. Currently, many patients with acute pain who fill their prescriptions at CVS receive prescriptions for 20 days or more, according to Troyen Brennan, CMO at CVS.

    CVS also will limit the maximum daily dosages for patients with chronic pain to 90 morphine milligram equivalents (MMEs), a standard measure of pain medication, Brennan said. According to CDC, a dose of 50 MME is the equivalent of 33 milligrams of oxycodone, while a dose of 90 MME is equal to 60 milligrams of oxycodone.

    Further, CVS said it would "requir[e] the use of immediate-release formulations of opioids before extended-release opioids are dispensed."

    According to CVS, the company in February will begin sending opioid prescriptions back to physicians for review if the orders exceed the new limits. However, CVS said providers will be able to appeal limits through a prior-authorization process. Further, employers and insurers will be able to opt out of the limits if they wish, though CVS has said it believes few will.

    CVS said the new restrictions are based on recommendations that CDC put out last year. "In light of the human suffering and financial costs caused by the current epidemic, a thoughtful, responsible, evidence-based treatment of pain is a service we must provide to our patients," Brennan said. "Employing principles sanctioned by the CDC is clearly necessary and prudent."

    Mixed reaction

    Walid Gellad, a physician at the University of Pittsburgh, expressed concerns about the new restrictions. "The guidelines that CDC put out were for prescribers to try to avoid those doses," Gellad said. "They were not meant for payers to say we're not going to fill something if it's above that limit"

    Separately, Gary Mendell—the founder of Shatterproof, a not-for-profit that aims to fight substance misuse—praised the new restrictions, but he said they are "at the upper range of the CDC guidelines," and that there was room for CVS to go further. CDC recommends that physicians prescribe between three and seven days' worth of opioids for patients in acute pain, and that, for chronic pain patients, doctors "carefully reassess" doses of 50 MMEs per day and avoid doses of 90 MMEs per day (Whalen, Wall Street Journal, 9/21; Bomey, USA Today, 9/21).



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