CVS Limits Opioid Use

CVS announced that it will be taking a variety of steps to help combat the worsening opioid crisis. The steps involve both CVS retail locations and pharmacists, as well as changes to CVS Caremark, its PBM.

The biggest change is coming to CVS Caremark. The PBM announced that it will being limiting the supply of opioids dispensed for acute conditions to 7 days. It will also be limiting the daily dosage of opioids and requiring the use of immediate-release (IR) formulations before it will dispense extended-release (ER) formulations.

Related article: DEA Wants 20% Reduction in Opioids

According to an article posted in Health Affairs by three executives at CVS, Troyen Brennan, Richard Creager, and Jennifer M. Polinski, the new regulations will put CVS Caremark more in line with CDC recommendations for opioid prescribing. CVS did not state explicitly what the new morphine milligram equivalent (MME) limits will be on daily amounts dispensed, but the CDC lists 90 MME/day as its recommended limit for opioid prescriptions. “The CDC Guideline,” they said, “should become the default approach to prescribing opiates, a scenario in which physicians would have to seek exceptions for those patients who need more medication or longer duration of therapy.”

Critics of such measures say that hard rules can deny access to patients who need these drugs, and that they don’t allow for physicians to make decisions based on individual patient need. In the Health Affairs article, the authors said that, “To be sure, prescriber autonomy and respect for the physician-patient relationship are of paramount importance. However, there is little evidence to show that past opioid prescribing habits are necessary or appropriate, and there is a great deal of evidence that they have produced significant harm.”

The authors claimed that PBMs are “better placed than others” to enact those guidelines. “Retail pharmacists have opportunities to provide patient counseling about opiates, and are required by the Controlled Substance Act to exercise a ‘corresponding responsibility’ as to whether a prescription was issued for legitimate medical purpose. But when faced with a valid prescription written by a medical professional, it is difficult, and often not appropriate, for retail pharmacists to take it upon themselves to limit prescribing,” they stated.

These changes, while a large step for the chain, are not radical. In February,

that it would be limiting opioid dispensing to a 10-day, 90 MME/day or less dose. Express Scripts announced similar plans in August, opting for a limit of a 7-day supply not exceeding 200 MME/day. They also require using an IR formulation initially.

Related article: How to Beat the Opioid Crisis

In addition to changes to their PBM, CVS has also pledged to increase its support of education and medication-disposal programs. CVS already has already donated more than 800 medication disposal units to police departments across the country, and has committed to adding 750 in-store units that offer free medication disposal. The chain made other commitments including:

• Strengthening its patient counseling options; pharmacists will discuss the risks of dependence and addiction tied to opioid use and answer patients’ questions.

• Adding $2 million to previous investments to support federally qualified community health centers providing medication-assisted treatment and other addiction services.

• Expanding the Pharmacists Teach program-which brings pharmacists to local high school health classes-to include an abuse prevention option for parents.

"Without a doubt, addressing our nation's opioid crisis calls for a multipronged effort involving many health-care stakeholders, from doctors, dentists and pharmaceutical companies to pharmacies and government officials," said Larry Merlo, President and CEO of CVS Health in a statement. "With this expansion of our industry-leading initiatives, we are further strengthening our commitment to help providers and patients balance the need for these powerful medications with the risk of abuse and misuse."