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 (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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  • My question is, why in hell does anybody even shop at CVS? This is a company that doesn’t deserve to even exist anymore. It’s bad enough that politicians with no medical experience or patient familiarity are telling our doctors how to practice medicine… why should our pharmacies start acting like it’s their business to tell us whether we can have the medication our doctors have prescribed, much less how we’re allowed to pay for it? It’s outrageous that we even have to have this discussion.

  • Dan,

    Do you pay cash b/c its cheaper than billing ins, with a co pay? Im thinking the pharmacy may get paid more if they bill the insurance. Whatever the case the pharmacy’s decision to deny your paying cash, probably benefits them.

  • CVS told my I needed my Drs. authorization to pay for my oxycodone with cash, although I havent used insurance for eight months.

    • So many things about the restrictions on Oxycodone (the politically incorrect drug) make no sense at all; especially CVS ignoring Dr. orders and abusing customers. Our politicians know what their doing and could care less; because they know that the rules will not apply to them if they are in severe pain.

      The fact that you are paying cash is really irrelevant b/c there is a data base that shows what your last script and the dosage. My question is, why are you paying cash “IF” your insurance co pays.

    • It is my experience that some CVS pharmacies will come up with almost any excuse to not fill oxycodone and I don’t know why.
      Excuses range from:
      I have to call dr. and dr. does not call me back
      We are out of stock
      Its too early (even if dr. writes “Can fill today”)
      And as you mention: We cannot accept cash.
      Just take your script to another location!

  • One CVS Pharmacy is constantly interfering with my Dr.s orders for my necessary pain medication, and flat out refusing to fill my prescriptions!
    I have to take these medications due to traumatic injuries suffered from 4 serious car crashes, three surgeries, and nerve damage that won’t heal!
    Every time I get a prescription, they make up an excuse to not fill it!
    And not once have they cited this policy!

    • Every time you go a different pharmacy you have to go through that same ole beurocratic BS. It sucks. And then they might not even except you. And then you’re stuck with nobody.

  • I hope this comment is about the above story.
    Cherokee nation should have no rights to sue anyone because they get hooked on anything.
    Before you get your bloomers caught I’m more than 1/2 Cherokee myself and am easily prone to get addicted myself. And believe me I have no problem calling anyone puts a needle snort or smoke anything to get high. You’re a junkie stop making it sound anything other.
    People are going to get high nothing anyone other than the junkies will ever fix that.
    Stop putting everyone that control their medical and life choices responsibly in the same box as a thief and drug abuser.

    • B.I.D. means twice daily. So if you are taking medication and you see the doc or pharmacists schedule for your prescription as BID you will take it twice a day

  • Ricky: The only times using more than one pharmacy should be an issue, is if they’re all written in the same prescription slip. If your doctor writes pain meds on one slip and everything else on another, you shouldn’t have any problems.

    If you were filling pain meds at two different pharmacies though, you’d have big problems. Most States have, or are getting, Statewide databases where any physician or pharmacist can see everything you’re getting, where you’re getting it, and who’s prescribing it… not a problem for those of us here who are following the rules anyway.

    • No, I`ve never filled two pain med. scripts at different pharm`s.And I have a problem with idiots that do shit like that.All I wanted to do was use my ins. to pay for 3 scripts.(lisinopril,pravistatin,Meloxacam) and pay for my pain meds like I`ve been doing for 10 years.All because I didn`t want to go through all the BS we go through changing pharm`s with Pain meds. My pharm. said fill them ALL here or go somewhere else. Yes,my Dr. know`s when I filled my script.I follow the rules.

    • I’m surprised that anyone would prescribe lisinopril and meloxicam to the same patient because those two drugs interact with one another. What sore of Med School did your doctor graduate from? Any pharmacist should also warn you and your doctor that this is an issue.

  • It’s so hard to believe CVS is getting away with this. It seems some of your insurances force you to use this pharmacy. I dont have to deal with them but I do deal with a lot of the restrictions and the junk generics they are passing out that make you sick in many different ways.

    Do any of you comment on your local CVS yelp page. It might give more exposure to this injustice and cruel and unusual punishment. I had to call 911 recently b/c of severe pain. One of the emt workers told me that 99.9 of their calls for opioid overdose was for people who obtained the narcotics illegally; no prescription. That says something.

    • Ricky,
      I think that you meant to reply to my comment above.

      It’s good that you have had a problem so far. You also could have smoked cigarettes for many years without yet having any problems, but that does not make it safe. Once you have an adverse event, it might be too late.

      Your doctor and your pharmacist should be embarrassed if they don’t know about this issue. That being said, pharmacists have access to software that identifies inappropriate drug combos, and they can look this up for you. If they are good pharmacists, then they would be happy to help your out.

    • Ricky,
      I meant its good that you have NOT had a problem so far.

      These issues are like negative lotteries. Changes are you won’t have an issue, but this increases the likelihood that you will. Your doctor and your pharmacist are getting paid good money to keep you safe, and they should help you out.

  • The reason there’s no cost at CVS, is probably because you’ll get no pills. I’d pay full cost somewhere else if I had to, because if you need them, money isn’t even part of the equation.

    • Yep,thats what I`m doing..Sticking with Publix..I wish the policy about splitting up your scripts to a different pharmacy wasn`t such a big deal..I`d like to keep my Pain meds at Publix and fill my blood Pressure,cholesterol,and sleep disorder meds at CVS…

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