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VS 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.

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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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  • First and foremost it was in fact the pharmaceutical corporations and pharmacies that are at fault and for all of these deaths!!!! That is not an opinion but a fact!!! It’s the pharmaceuticals that are turning people into zombies and filling more and more cementary… It’s the pharmaceutical corporations that makes these drugs that are in fact worse for you in the first place and they are the ones making BILLIONS of dollars every year… Now that CVS has made their billions of dollars off the opioids they are now willing to cut it back… But does this actually help the millions of people who are legitimately in chronic pain? Nope and what CVS, the DEA and Legislaturion is causing is the birth of another epidemic… How? Because people who are legitimately in pain will commit suicide because the pain is too much or they will turn to heroin or some type of other drug which is currently happening as I type this!!!!! See the pharmaceutical companies are at blame for everything and I mean 110% of everything… Do you want to know why you get more flus now than we did 40 years ago it’s because of the over prescribing of antibiotics… People will say that’s the doctors fault but to the contrary it’s actually the pharmaceutical corporations that are at fault…

  • Dear Pharmacist,
    You might be correct regarding libel, but I did not see anything saying so after I quickly searched. I will find out what I can do. You outright stated something about me that is not true. I found it a lie, not just offensive. Also, if one is titrated and correctly aided in being taken off meds, one should not go into withdrawal. Though I am not pleased with your comment in the earlier post, I am going to keep this blog about the main point. The main point is that taking people in pain off of meds is a nasty and short sighted. If anyone really thinks this is going to stop addiction, they are sadly wrong. Ever heard of Prohibition? That did not work. It made criminals out of people for drinking a glass of wine. It also made Al Capone very wealthy.
    And speaking of that, why do we sell alcohol? That creates alcoholics. Even the CDC guidelines are not mandates, are they? Instead of CVS helping the people and trying to find a sensible solution to this, it seems they are instead taking a rigid stance. I have seen a young friend suffer in severe pain for several years. Finally a pain doctor was able to get the meds right and she is living a bit of a life. Now all the pain will return. This person has done accupuncture, Reiki, and many things. Also goes to physical therapy and swims in a warm pool. A friend’s husband was already pulled off the pain meds last year. After several months of horrid pain with which the opioids had helped, he is no longer with us on earth. I think you know why. We cannot solve the problem of people who get addicted on the backs of those who need these meds and have been strictly monitored. The addicts misused the drugs and there are usually other reasons involved.

    • Ask CVS if they really cared so much why did it take them years to quit selling cigarettes and ask them why do they still sell alcohol which in fact kills more people every year than guns and drugs do!!!! That is a fact…It’s hilarious that our government is so worried about opioids but alcohol kills more people than opioids ever will… So tell me who is backwards here?

  • Since I don’t know you I can’t be libeling you. My comments therefore are protected under the First Amendment. My apologies if you were offended.

  • Dear Pharmacist, (If you really are one),
    If you noticed, I apologized for my comment in triplicate. When I submitted my comment, it kept telling me it would not submit. It did so two times, so I kept hitting the submit. Also, I have been very lucky with my health, thank God. I am not on any pain meds. I barely take aspirin, thank you. You are making quite the assumptions in a rather hostile manner. I am considering showing your comment to a lawyer. It is libelous. I just need to decide if it is worth it.

    • Apologies again, as I didn’t know that you were not on pain pills until your very last comment. And as to your comment about diabetics, I happen to be a severe Type 2 diabetic myself, and just today my doctor told me I was NOT getting any more drugs, and proceeded to scold me for not losing weight. So that even for me and the other millions of Type 2 diabetcs drugs are NOT always the answer. Actually if I lost 40 pounds my doctor COULD take my antidiabetic meds away because I wouldn’t need them anymore.

  • CVS and their pharmacist are absolutely out of line obviously they or their family members have never had to deal with extreme pain on a daily basis. I pray they never have to . I’m 68 yrs old suffer from severe pain in just about every joint. Without my prescribed amount of pain meds I would be in a nursing home next to my sister in a diaper filled with feces and a catheter stuck in me sitting in a wheel chair instead of living on my own and taking care of myself. I will never use CVS again

    • You made your point in triplicate. You are dependent because if your pain pills were yanked you would go into withdrawal. Better listen to our President Trump and start investigating non opioid pain management for despite your responsible nature you are being swept up in the net with the lowlife addicts, who will make it impossible for you to get your narcotics without having to show up to the pharmacy on a weekly basis in the future.

  • This is to the pharmacist who declared “dependence is dependence…period.” Yes, dependence means the same as dependence. Same word. Same meaning. But it does not mean abuse! Abuse is misusing something. Addicts are abusers of drugs. An abusers life usually goes downhill. A chronic pain patient is relying on drugs that have been strictly prescribed and strictly monitored to help with pain. A chronic pain patient usually sees life getting better because the drugs are helping to alleviate the pain. Perhaps they can seek to actually live some type of life. The medical community probably did oversubscribe, so there need to be changes. But we can’t take a 180 degree turn and leave chronic pain patients with hardly anything. Medicine is a science, but also an art. Pharmacist, you should know that. What works for one person may not work for another at the same dose. I know of a chronic pain sufferer who has been on opioids for years. Guess what, since he got on them with the correct dose, he has gotten up each day for years to go to work and take care of his family. Now you are going to take that a way? You don’t see that as cruel and inhumane? I guess the medical community has forgotten about “First, do no harm.” Most chronic pain sufferers are not addicted. Would you take insulin from a diabetic?
    I hope that you or anyone in your family never suffers from chronic pain due to a chronic illness or an accident,etc.

    • you are so right.whats the difference for a patient that takes other meds to help him such as blood pressure, insulin , or any thing else that helps you get along.i couldnt get my pain meds filled today after going to 3 places.my pain med helps to take the edge off for awhile and allows me to at least function some what normal.iv avoided back surgery for several years because of managing my pain and not the knife, which may cripple me or make things even worse.there is sure thing with getting cut on. i decided 2 years ago to see how i could function with the lowest dosage of hydrocodone and had my doctor cut me back to 2 pills a day from 4.this doesnt sound like a junkie to me. im suffering now because i dont have my pain pills and hope to get them filled from cvs tomorrow but they put off today at 2 different locations.this is not right for me to have to deal with.i spent over $200 for the doctor in which i see every 3 months along with a mandatory drug test, ordered by the federal gov.im getting to the point now, at 65 years old to tell my doctors to keep their bp, diabetic med. pain pills and all the 4 months annual visits.ill just survive on my 10 ounces of red wine a day and say thank you very much.i spend a small fortune on my health care, several thousand $ a year and im not happy at all in what im having to go thur here.i guess all the pain doctors will now close their doors because they wont have any patients if they cant get the scripts filled.you can write them all day and its not going to matter.wish everyone a merry christmas and happy new year.

  • This is to the pharmacist who declared “dependence is dependence…period.” Yes, dependence means the same as dependence. Same word. Same meaning. But it does not mean abuse! Abuse is misusing something. Addicts are abusers of drugs. An abusers life usually goes downhill. A chronic pain patient is relying on drugs that have been strictly prescribed and strictly monitored to help with pain. A chronic pain patient usually sees life getting better because the drugs are helping to alleviate the pain. Perhaps they can seek to actually live some type of life. The medical community probably did oversubscribe, so thete need to be changes. But we can’t tale a 180 degree turn and leave chronic pain patients with hardly anything. Medicine is a science, but also an art. Pharmacist, you should know that. What works for one person may not work for another at the same dose. I know of a chronic pain sufferer who has been on opioids for years. Guess what, since he got on them with the correct dose, he has gotten up each day for years to go to work and take care of his family. Now you are going to take that a way? You don’t see that as cruel and inhumane? I guess the medical community has forgotten about “First, do no harm.” Most chronic pain sufferers are not addicted.
    I hope that you or anyone in your family never suffers from chronic pain due to a chronic illness or an accident,etc.

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