CVS Health announced Thursday that it was limiting the amount and strength of prescription opioid painkillers it provides to patients taking the drugs for the first time, a step intended to help curb opioid abuse.

Through its pharmacy benefit manager, CVS Caremark, which has 90 million plan members, the company will introduce three new policies, effective in February. First, patients new to opioids will only get seven days’ worth of medication. The program will also limit daily dosages and require that immediate-release formulations of drugs be given before extended-release versions are prescribed.

Doctors can ask for exemptions for certain patients, CVS said, and employers and insurers can opt out of the program.

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CVS said the new rules will bring the company in line with prescribing guidelines issued by the Centers for Disease Control and Prevention last year. In a Health Affairs blog post, CVS officials estimated that 61 people at a company of 100,000 employees would avoid becoming addicted to opioids in a given year if those guidelines were followed. The estimate, they said, was based on commercial insurance data.

“The CDC Guideline 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,” the officials wrote. “What is more, pharmacy benefit managers are better placed than others in the pharmacy supply chain to put this approach to the CDC Guideline into practice,” as opposed to medication wholesalers or retail pharmacists.

Based on the CDC’s recommendations, CVS’s new daily dosage limit is 90 morphine milligram equivalents, or MMEs, a measure of the strength of a painkiller.

As part of the new effort, CVS Pharmacy sites will also offer enhanced counseling and education campaigns about opioid safety and addiction.

The move by CVS could fuel the debate about whether doctors, PBMs, and pharmacies are reacting too stringently to the opioid epidemic, tightening access to prescription opioids so that patients with legitimate pain problems cannot get the treatment they feel they need. Another large PBM, Express Scripts, previously announced it was planning to limit the supply and dosage of opioids for first-time patients, a move the American Medical Association warned was a “blunt, one-size-fits-all approach” that took treatment decisions away from the doctor and patient.

Increasingly, heroin and the illicit use of synthetic opioids like fentanyl are responsible for fatal opioid overdoses, but many cases of addiction begin with prescription painkillers. In some cases, people will start taking leftover medicine originally prescribed to someone else.

CVS also announced Thursday it was adding another 750 medication disposal kiosks at its pharmacies around the country, roughly doubling the number that CVS has helped open as of now.

The roots of the opioid epidemic are multifaceted, but pharmacies and PBMs have been accused of allowing painkillers to flow into communities with few limitations. Earlier this year, Cherokee Nation sued CVS and other companies, alleging they helped fuel an addiction crisis in the tribal community.

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  • Bruce: I’m sorry, my doctor said the burning pain in my elbow was probably bursitis. She also said she thought my knee pain was arthritic, and my Xray showed a “narrowing” of the joint, which she explained had to do with the thickness of the cartilage. I’ve led a pretty physically active life in the construction industry, and at 71, I’m still more physically active than I should be, and it’s taking its toll on me now… I’m just not ready for the rocking chair.

    I did discuss back surgery with a couple of orthopedic surgeons, and they were honest enough to tell me I’m better off managing the pain with medication for as long as possible, because surgery is risky. My ex-wife is an RN in an orthopedic ward, and she’s told me the same thing, based on hundreds of patients she’s seen over the years who had back surgery. Sometimes they feel better for about a year, then end up much worse. I don’t like dealing with all the pain politics, but I’ve managed the pain with responsible use of opioids for around ten years now. Apparently, many people are unable to do that without getting themselves into trouble. Moderation and willpower are the key… I know I have no choice but to follow the rules and only take what my doctor allows. She’s the gatekeeper, and I’ve learned to respect the fact that she keeps my opioid usage from spiralling out of control. When the pain is telling me I need another pill, I know the other side of that is I need more rest, and I’ve learned not to feel guilty about spending a few days in bed watching TV instead of aggravating my inflamed muscles further.

    My mother had arthritis in her fingers, and was allergic to aspirin and most NSAIDS, so she had to take Prednisone. As a result, her immune system was weakened, and she died of an upper respiratory infection, which had plagued her for years. When she died at 79, her fingers were grotesquely twisted. Had she not taken the Prednisone, she might have lived longer… in excruciating pain. Life is full of tradeoffs.

    • Jim,
      As I said, I can understand why you might not want back surgery. It sounds like you made a good effort to resolve things. I wasn’t criticizing you, although I tried to make a couple of helpful recommendations.
      It sounds to me that the arthritis in your knee is probably osteo-arthritis, which occurs when the cartilage wears down. Rheumatoid arthritis is an auto-immune disease.
      It does not hurt anyone, including myself, to try to avoid inflammation.

  • Was at CVS for 2 years and recently left.
    I suffer from a moderate stage of Rheumatoid Arthritis.

    Fibromyalgia and Degenerative Disc Disorder in my lower back too.
    I’ve done physical therapy more than once, I have a tens unit I’ve done
    massage at 60 bucks a pop ,CBD oil just makes me tired had a Medical Marijuana Card I don’t want to be stoned Antidepressants too those made me feel worse Kratom even… bluch .
    Arthritis drugs that made me sick, DMARDs group ,elevated my liver I can’t take them.
    Now I have Diverticulitis and can’t take NSAIDS like Motrin or Advil as I have taken those things for so long for pain.

    CVS made me go back to the drive thru 5 times one day just to get my pain meds.
    I have been yelled at treated like an idiot.
    Anyone can see the RA in my hands.

    So I called the manager who actually was nice and told them I’m gone.

    So I go to another pharmacy now just one thing.

    They will only fill a horrible generic that is a weak imitation of a pain med. They would not order a brand name from my pain doctors electronic prescription.
    “ what we have on our shelf is the only thing we can get”
    My pain doctor had to up the dose as my RA flaired up so bad I cried.
    Then my health insurance sent me this letter
    “ We noticed your pain med dose went up”

    Mean while there are politicians and others who will approve needle parks where drug addicts can shoot up.

    There should be law suits from people who can’t take anything else and have tried it all and who have been harassed because that is what this is!

    If I wanted to get high I wouldn’t sit around waiting for my insurance or drive across town and pay a monthly fee as well as per in a cup every so often!!
    It’s so I can get up and live my life.

    This is just out of control

    • If you have rheumatoid arthritis, then why are you going to a pain doctor and not to a rheumatologist?

      Any competent doctor treating rheumatoid arthritis would put you on a diet that reduces or eliminates RA symptoms. How long have you been on this diet, and are you following it?

    • Bruce: I would assume the OP is seeing a pain specialist because he’s in pain. I see one because I have three herniated discs and bone spurs in my lumbar region, and I’m old. The meds aren’t a perfect solution, but they’re the only solution. I recently started getting searing pain in my elbow occasionally, which my doctor says is RA, and an Xray of my knee shows the cartilage is becoming thinner, promising future problems with that joint… plus there’s a big knot of calcium deposits floating around right below my knee. I have no idea why it’s there, but at least that doesn’t bother me.

      You mentioned that the OP should be seeing a dietitian to treat his RA. I’ve never heard of this, so how does a special diet help, and what should he (and probably me) be eating? I started taking liquid collagen every day, but have no idea whether it helps or not.

    • Jim,
      Your situation sounds much different than RA’s situation.
      Pain is an indication that there is some sort of problem. The first thing that should be done is to try to treat the problem. If it’s not easily treated, then treating the pain is a 2nd best solution. If you have herniated disks, I can understand why you might be reluctant to get back surgery, due to adverse results in many cases, although you should certainly check with an orthopedic surgeon if you have not already done so. You should also google the Mayo Clinic for their info on herniated disks. The Mayo Clinic is very well respected. I’m surprised that you have an issue with RA is you are old. RA typically peaks in the mid 50’s and tapers off after that. I used to have RA in my fingers, but the problem pretty much disappeared when I hit my late 50’s. There are always individual exceptions, however.
      In RA’s case, there is no indication that he/she went to a rheumatologist to treat the problem. Just as someone with a painful heart condition should go to a cardiologist, RA should have gone to a rheumatologist. This link from Harvard Health has a good list of foods to eat and foods to avoid for inflammation. Fatty fish and nuts are especially good. The link does not include foods with omega-6 fatty acids, but one should also try avoiding poultry and other foods high in omega-6 fatty acids. There is a medical debate on omega-6 fatty acids, and Frank Hu from Harvard defends omega-6 fatty acids. I have a lot of respect for Hu, but it would not hurt to see what happens if you avoid omega-6 fatty acids for awhile.

      https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation

  • We’ve been talking about this issue here@stat for at least two years now, and everyone afflicted with permanent, life-altering pain issues agrees that the current version of The War On Drugs is misguided and fails to differentiate between drug abusers and those who actually need and benefit from prescription medications to maintain functionality and quality of life. Those who have never been cursed with unrelenting chronic pain every day of their lives, often seem to lack empathy for those of us who have to live with it.

    Politicians are not doctors, and have no business coming between legitimate doctors and their patients. Why are we being considered no different from recreational drug users who don’t need prescription opiates to manage legitimate chronic pain?

    When lawmakers and the news media blurt out statistics about the number of opiate overdose deaths, what percentage of those deaths are actually attributed to patients under the direct care and supervision of a licensed doctor, who are taking their medication strictly as prescribed, versus recreational drug users buying heroin or fentanyl on the street, not knowing or caring what they’re taking, as long as they get their next high? I’ve never heard any reliable statistics that indicate that there actually IS a significant problem with responsible, doctor-supervised opiate use… does anybody even know, or are we just considered “collateral damage” because lawmakers can’t be bothered to separate one from the other?

  • Thanks everyone who responded. It’s good to know that I’m not alone or in the wrong on this. I think that if we confront pharmacy issues as they present themselves then common sense may prevail in the long run, keep the faith…

    • CVS is a lost cause and really doesn’t deserve any “second chances” after treating patients that they had been filling pain medications for years as drug addicts. For me, I was dependent on opioids after 18 years of successful treatment only to be refused my normal prescription and launched into full blown withdrawal. How can that in any way be justified for any corporate decisions.

  • Key term “New Users” which I am not. Yet, the youth, the clerks at my local pharmacy delight in limiting my Tramadol to a max of 15 tablets at a time, a one week supply for me, which is totally ridiculous. Especially when my doctor prescribes 90 pills at a time, a six week supply. So, a couple of times now I’ve had to go to the pharmacist who checks with CVS online and sees that CVS themselves authorize me to receive up to 60 tablets at a time. I can live with that and on an order of 90 receive 60 with the other 30 held for 30 days at which time I come in for those. But, to think that every Friday afternoon I’m to stop whatever I’m doing in my busy life and drive to CVS and stand in line for a dole out is a waste of my precious time and an insult to my integrity, and totally unnessary! Move over Big Brother – Big Pharma is here

    • Find a new pharmacy. I did and have no problems filling my prescription. I will never set foot into another CVS again.

  • Telling patients what they can have is practicing medicine without a license. The doctors should be determining the appropriate dosages.

  • this os the exact reason the herion epedemic is so bad your not a doc to determine wat s patient needs for pain your crossn a line thats not for you to cross

  • CVS…it should be clear to all how transparent your actions are. It is a proven fact that CVS was close, even partners with CARDINAL HEALTH…the company that was mainly instrumental (aided and abetted by CVS…who is now looking to be the DEA darlings of the Opoid “Epidemic” ruse!
    Dear CVS…there is NO amount of PR you can pay for that will wash the filth off of your corporate mitts! YOU are CRIMINALS…NOT the poor souls who only want to live a life RELATIVELY pain free.
    Some of your corporate officers SHOULD be prosecuted, but I suppose this “dispensing weekly and at the CDC laughable and inhumane 90/mme “guidelines” was enough of a start to keep you crumbs out of the Federal joint.
    Time will tell.
    Meanwhile, it would be wise to remember that bureaucracies, such as the two you are in bed with (CDC, DEA) will supp on YOU if they run out of prey. Tread lightly. Your day will come. Count on it.

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