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.


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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  • Currently CVS Pharmacare is ignoring the science behind medication for chronic pain. I can say for myself at least that the new guidelines are beyond anything reasonable…. I have been on the same long and short acting medications for about 17 years, now CVS wants SHORT acting meds before long. So I am supposed to take More meds more frequently, and suffer less relief over the long term. They changed the guidelines regulating my long acting meds, 5 10 mg tabs 3 x day, after being on the same dose for the last 15 yrs, they arbitrarily reduce me to 4 a day, 120 a month, not allowing for a proper tapering, nor advising Anyone that this was being done. After filing a complaint I was notified that the following month, ( Feb/2018) they would further reduce to 60 tabs. So come Feb 2018, lo and behold my Pharmacist notifies me that a Prior Authorization was now required, and that they had denied it. Strangely enough unlike other denials he has seen over time with this Company, no guidelines or explanation was given. I had, through my own means, had gotten the guidelines. This effective, non hepatoxic medicine was now Only ok’ed for use for those DYING, hospice care or terminal cancer.
    So here we have it. A med that I had safely used for 17 yrs, I have liver disease and no not from drinking, something I was infected with overseas, Hep B, C, and D. Denied the Normal tapering off, forced to use a short acting med that I normally used as a Break through med (as needed use) not constant daily useage, pain for a failed spinal surgery, dessicated disks, bilateral sciatica, nueralgia, degenerative disk disease, compression of nerve roots at the L5_S1 juncture, no feeling in both legs, other than one small area that senses touch as fire instead, and the soles of my feet sensing nothing but being on fire 24/7.
    Of course the paperwork they sent me, advising me that my long acting would be reduced further to 60 tabs a month, is totally ignored. Just so you understand, CVS/Pharmacare had been allowing my Prior Auth. requests for 7 years prior to this. The science directly contradicts their actions. If they are sincerely dedicated to (attempting) reduce fatalities related to opiates, Reduce the number of patients on BOTH benzodiazipenes and opiates, as THAT is a truly dangerous and, is in a large number of “opiate” related fatalities. Many if not most fatalities are from drug interactions not opiates alone. Also instead of targeting prey that is standing still go after the supplies on the streets. 😕😕😕 Yeah, you know, that war on drugs,that highly successful money maker thing. I will be looking to the UCLA attorneys to hopefully bring a class action discrimanation suit to bear.
    Good luck to all, I am in NYC so if you are one of us being targeted, please post a response so I will know to come and look. (I know, I know, what medications am I on? I held back because I did not want to prejudice anyone before they had a chance to read this……ok…. Methadone 10 mg. Tabs, 5- 3 x a day for a total of 150 mg a day, so distributed for use as long acting, rather than the MMTP style which is the entire dose at one go, (it would wipe me out). Then Dilaudid 8 mg. max of 4 a day, AS NEEDED. Not as they want now, to take the place of the long acting, taking it constantly, increasing my intake of opiate pain killers to ridiculously high levels, and using a med DESIGNED for Short term use to suppress breakout pain, hence the As Needed instructions.

    The insurance companies are abusing their position, in particularly CVS/Pharmacare which , according to several Very frustrated pharmacists, owns about 70% of the prescription market in NYC medicaid.
    Sorry for the length of this post, just trying to accurate and concise. Thanks to all.

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