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.

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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.

  • My pharmacy lets me fill my pain meds 3 days early…I guess there`s a 3 day window they will allow a refill…But I don`t abuse it..I tell them I`m in no hurry,just dropping it off…And let them call me when it`s ready..But I see my PM Dr. every month($80.)sometimes it`s a week before my script runs out..It`s just the was they schedual appointments..

  • Patricia, ten X 10mg per day is a LOT! I’m surprised your doctor prescribed that many. Even eight a day is a lot. Sixty mgs of Oxycodone is 90 mme’s (they multiply the mg by 1.5), which I think that the so-called “guidelines” say should be the max now. I’ve found that if I have a couple of really bad days and go even 10 mg over my normal allocation, it’s hard to go back down again. Having to drop from 100 mgs a day must have been pure hell for you. The problem with opiates, is the more you take, the less they work. By the time you get up to 8 or 10 a day, adding one more would hardly make a difference in the way you felt. It leaves you nowhere to go. They should have at least tapered you down slowly.

    I’m taking 45 mg of Oxycodone a day. They’re 10 mg tablets, and I always break them in half, taking 5 mg at a time, so 4-1/2 pills a day. I do that so I’m not “wasting” any by taking more than I need to take the edge off the pain. I also take 15 mg of MS Contin twice a day (Morphine). It must not be the same as injectable morphine, which I’ve never had, but that’s supposed to be pretty powerful. I can’t feel that the Morphine is actually doing anything, but my doctor says it works differently, long term, and helps smooth out the gaps. I was doubtful, so I quit taking it to see what would happen. I was fine for 2 or 3 days, but then I started needing more Oxys, so I guess she was right.

    My pharmacist said I was taking a “pretty high dose,” but I’m only at 97.5 mme’s, which I’ve taken for years without any problems ever. I budget my meds stricter than I do money. Now I’m being made to feel like an addict for taking any opiates at all. I sure wouldn’t go through all the trouble I have to go through just to get “high”… I don’t even smoke or drink. I just want to be functional and have as “normal” of a life as possible.

    I injured my back working in construction when I was in my Twenties, then had a bad fall in my Forties. Even now at 71 and retired, I’m completely remodeling my house, inside and out… I’m not ready for the rocking chair yet, but I have learned to slow down and allow myself to spend the day in bed healing when I feel I need to. Sometimes it hurts to work, but sometimes it hurts more to lay around and do nothing. I’m doing everything I can to have a normal, functioning life, but the politics are making it harder every year.

    Why are people with legitimate chronic pain being lumped in with junkies who are mostly overdosing on illegal, injectable drugs? Would it be asking too much for the people making all these rules to recognize that there’s a difference, and make some accommodations for us? I think a case could be made that current policies violate the Americans with Disabilities Act, and I sure don’t understand why insurance companies are acting as the gatekeepers who decide what amount of medication is appropriate for a patient, when they aren’t our doctors, they haven’t examined us, or seen our MRI’s. How and why did we ever get to the point that an insurance company… not a trained doctor… makes that decision?

    • well now the pharmacy they get crazy if u try to get your script filled 1 day before the 30th day, it’s a leap year april 2020, 29 days, now I’ve delt with brookshires here in east Texas for 10 yrs and the DEA has also given the pharmacist the power to not give you that script due to the fact u might be at risk to overdose. you think it’s a problem with the government getting in between u and the dr? just think about the person behind the counter having that much power over you at the pharmacy of your choice…..now thats really not right at all….

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