Would partial fill curb opioid abuse?

Sen. Elizabeth WarrenIn an attempt to curb prescription opioid abuse, two members of Congress recently introduced legislation that would allow pharmacists to partially fill opioid prescriptions.

The Reducing Unused Medications Act of 2016, introduced by Massachusetts Democrats Sen. Elizabeth Warren and Rep. Katherine Clark, would allow opioid prescriptions to be partially filled if requested by patients or doctors.

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The reminder of the prescription could be filled at a later date, but not beyond the original expiration date. Massachusetts, meanwhile, is considering legislation that would allow patients to request a partial fill for opioid prescriptions with a proportionate reduction in their co-pay.

"Tackling the opioid abuse epidemic will be tough, but we can take an important step by reducing the number of pills in circulation. This bipartisan bill will empower patients and doctors to work together to determine appropriate pain treatment, while limiting the number of unused pills left in family medicine cabinets,” Warren stated in a release.

“It also gets the federal government out of the way and empowers states like Massachusetts to pursue additional prescribing policies that are the right local responses to this terrible crisis,” Warren said.

Both Warren and Clark believe the bill is needed to empower individual states to take action.

"Millions of half-filled bottles of unused prescription drugs line our families' medicine cabinets, and too often, that is where opioid addiction begins. [This bill] empowers patients to manage their prescriptions responsibly and reduces the number of unused and unwanted painkillers that are fueling our nation's opioid epidemic. Democrats and Republicans should come together to pass this bill and save lives," Clark stated.

Pharmacy groups respond

Stacie S. Maass, BSPharm, JD, the American Pharmacists Association’s (APhA) senior vice president, pharmacy practice and government affairs, said APhA supports mechanisms, such as allowing partial filling of Schedule II prescriptions, to help curb prescription drug abuse, misuse, and diversion while limiting waste.

“However, we have concerns regarding how partial-fill provisions will work in practice, especially whether patients’ copays will be adjusted for partial fills and costs related to dispensing schedule II medications will be adequately covered,” Maass told Drug Topics.

Susan A. Cantrell, RPh, CAE, CEO of the Academy of Managed Care Pharmacy (AMCP), said that group hasn’t yet taken a position on the partial-fill legislation.

“Managed care organizations have well-established techniques that prevent individuals who have a history or suspicion of inappropriate utilization from visiting multiple doctors and pharmacies to obtain illicit prescriptions,” Cantrell told Drug Topics.

“We support recent legislative and regulatory efforts to let Medicare Prescription Drug Plans and Medicare Advantage implement drug management plans (DMPs) that restrict participants to a single prescriber and/or pharmacy (or chain of pharmacies),” she said.

The American Society of Health-System Pharmacists (ASHP) also seemed to be adopting a wait-and-see attitude toward partial-fill legislation.

 “ASHP shares the concerns of Senators Warren and Clark regarding the epidemic of opioid abuse. Although ASHP does not have an official policy on partially filling a patient’s controlled substance, we believe that all options should be examined to curb the amount of dispensed, but unused, opioids,” said Christopher J. Topoleski, ASHP’s director, federal legislative affairs. 

“ASHP will be further exploring the concept of partial fill in future policy discussions, including the logistics and details of how such an option would be presented to prescribers and patients,” Topoleski said.