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.

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  • I hear you, John. I was an electrical contractor, and beat my body up every day just to pay the bills. In return, I made the motors turn and the lights come on. It took a heavy toll on me physically over several decades of my life. Now I’m old and beat up, and need medication just to get out of bed every day. I’ve never abused my meds or taken enough of them to get “high”. I’ve never had a problem managing them responsibly, and as intended. Nobody seems to care about the stories behind why some of us are now being placed in this position, and made to feel like we’re now “junkies”.

    The real opiate problem isn’t chronic pain sufferers using meds properly, and under a doctor’s supervision. The problem is a wide-open border where illegal and dangerous drugs are pouring into our country every day, and a lot of liberals who claim to be so concerned about the “Opiate Epidemic,” but haven’t figured out where the real issue is, and have shown no inclination to address it.

  • You know? I commented about this “war on opiates” BS! When it was first mentioned in the media. I know there are abusers out there, I’m not naive. But, there are honest hard working Americans trying to make ends meet and raise their kids with a good education, keeping there kids off of drugs. Hell! Just putting food on the table with a $10 Big Mac meal. Prices are crazy now. So tell me? How the is someone who has been building power lines for 32 years supposed to keep doing his job and train newbies not to get killed! Especially when they are trying to take away my pain medication that I hav been on for 15 years? I only take them if I have pain and only when I’m not working. But! Since they are in my system and random drug tests happen at work. Now they are giving me a BIG stink about my meds. I have been doing my job without an accident, vehicle or otherwise, for over 3 decades. Now the abusers, and the government, is trying to basically put me on welfare because I have pain management to do my job. 32 years of climbing poles and lifting 500 pounds while standing on to tiny half inch pieces of steel between me and certain death on a daily bases. Hey! How about instead of going after those of us taxpayers that are going to doctors and struggling by the day to raise the next generation? Why not get your white collar hands dirty for once in your life and pass a law to keep criminals in the jails by building their on jails and put them to work. Figure since I pay taxes for their lazy but to sit in a cell? Why can’t they pay back in labor for their crimes instead of watching tv all day? Don’t be surprised when you see me there in a cell laying on my but on the taxpayers dim because I can no longer afford to pay my child support because I was legislated out of a job. Andrew? I don’t know much about you , but, you look pretty young and you boss probably gave you this assignment. Next time ask you boss if he takes any pain relievers and if he can no longer work because he was injured. Without those who are dependent ,not addicts, working while on pain management? Trust and believe. This country will come to a grinding halt and California will definitely be in the dark with no power whatsoever to charge cell phones or watch tv with. 90% of those who provide you utilities are broken and trying to do their jobs for you all. Please, let those who work keep working. Go after the criminals… or is that to difficult? More than likely, Joe blow is an easy target to hit because he pee tests and wants his job. Now Joe will be on taxpayer dime because someone wants to look like they are winning a “war” they started. It’s a joke. One last thing. To CVS, do not run into Walgreens pharmacists and let you employees start making desicions my doctor is only allowed to. The next time a pharmacist tells me they don’t like what I’m taking? I’m filing a law suit. Your a pharmacy. Fill my script and keep your mouth closed, that you job. I don’t need or want your opinion. If I wanted an opinion from you? Your name would be “ Doctor”. And, I’m starting to video tape every conversation with very pharmacist I deal with. They aren’t doctors and don’t get to tell me hat I should be taking and what they prefer I be on. You do not have a liscence for doing that. Especially at Walgreens. So take head CVS and be smart.

  • I wish everyone had your passion, and you’re right, people that were on long term opioid therapy should have been grandfathered in. What’s happening is cruel and unusual punishment and is actually unconstitutional. I agree that some pharmacists is going to get roughed up over their bullshit. I’ve read of a couple doctors getting blown away for refusing people in severe pain the relief they so desperately needed. The theory that prescribed medications are the cause of this so called epidemic is total crap. People have been using heroin forever, and then cane fentanyl and the overdose deaths soared. The DEA are a bunch of pussies who can’t deal with the cartels, so they pick on us law abiding citizens. It’s lazy and pathetic and the deaths will continue.

  • I mean CVS was back dooring the pills,they where a pill mill,payed there fines now make us suffer,bullshit,hope I. An change pharmacy

  • I doubt this will make any difference but you’re decision to override long time doctors in the specialty of pain management is wrong. People like myself who was hospitalized ten years ago for uncontrollable pain after pursuing every possible option other than medication will be condemned to suffer horrific pain and become confined to a bed effectively ending their hope of at least some simplence of a meaningful life. You’re policy will doom responsibly individuals to an eairler death just as sure as any drug overdose might. Their mussels including their heart will weaken due to inactivity and lack of excersive leading without question to an early and in pain death. I find this action by CVS cold and irresponsible. Doctors should be the ones dealing with guidelines regarding any medication, not a pharmacy. This decision by CVS is inexcusable and absolutely wrong. Not to be threatening in any way but I’ve no doubt some patients and families of loved ones will make this decision if it’s not reconsidered a legal matter. Any pharmacy adopting similar policies are reacting outside of what their mission statement should be and literally inflicting chronic pain on people that depend on their pharmacy to honor a physician’s diagnosis with regards to the medication therapy their patients require, especially from a pain management specialist. This is simply wrong. One size doesn’t fit all and any determination as to medication therapy should be left to the doctor patient relationships that are much closer and better managed than any pharmacy consumer relationships. I pray CVS will reconsider this irresponsible decision and choose to not to inflict pain by making pain management decisions which should be made by specialist physicians which have spent years studying and then practicing their field of expertise which a drug store has in no way done. If a pharmacy takes on this role they will more often than not make inaccurate decisions due to an absolute lack of information. They aren’t physicians and shouldn’t act like they are. Let trained physicians do what there’re trained to do and pharmacists do what there’re trained to do. Thanks for reading, now do what’s right, fill prescriptions for properly diagnosed conditions.

    • We should all complain to CVS corporate, complain to all government branches – Congressmen and state legislators and consult our lawyers so that this punishment of people who take pain meds responsibly will stop. The suicide rate is up for people now that doctors are taking their pain meds away but how arrogant of a pharmacy to think they know better than doctors who DO prescribe these meds. My husband was only given 28 pills and CVS said he could only have 7 days worth – because of their new rule! How outrageous!

  • The CDC reports limits should be based on morphine equivalents and names oxycodone, hydrocodone, and fentanyl; these are all Schedule II opioids. The media and agencies fail to acknowledge that codeine is an opioid, but a Schedule III opioid. Schedule III prescription opioids (and medications in general) have far less risk of dependency, addiction, tolerance, or overdose. I have been prescribed a Schedule III pain medication for chronic pain at the same amount for over 20 years. I have never had any problems with tolerance, dependency or addiction. Though I am prescribed about 60% of the number of capsules/month I am permitted (per the product manufacturer and FDA recommendation), I get far too much trouble from CVS about the number of capsules I take and feel like a criminal every time I have to fill it. I spent years trying every alternative known to specialists for my chronic pain: prescription medications (approved, experimental and off-label); over the counter medications; behavioral techniques such as meditation, hypnosis, and biofeedback; exercise regimens and diet changes; and acupuncture. There is no other alternative. It is hard enough living with chronic pain without pharmacies now stepping in and taking upon themselves how much an individual is allowed. Let the doctors who have one-on-one encounters with their patients do their jobs. It is not up to the pharmacy to make decisions over that of the doctors. The pharmacies don’t know anything about the individual’s condition or treatment plan. Limiting pain medication for people with chronic pain will lead to greater incidence of suicide as living with chronic pain is no life at all, cause them to seek illicit drugs, and result in greater number of overdoses and addiction as many street drugs are highly addictive and unmonitored Schedule 1 drugs e.g. heroine. A great number of studies have shown that the majority of people, ranging from 99% to 87%, DO NOT misuse their pain medication, nor become addicted, nor accidentally overdose. The vast majority of patients prescribed opioids take them responsibly – in truth they cant afford not to. (What chronic pain patient would want to become tolerant to their pain medication or lose the trust of their prescribing doctor?) For to live with pain, is no life.

  • Jim, well put….in the 80’s it was cocaine and crack, and until recently we kept hearing how maraqunia was so bad, it was a gateway drug, now apparently it’s ok. My pain management group recently sent me a message encouraging me to apply for a medical marijuana card…..uh…no thanks. They outlawed booze and it created mobsters who beat people to death with baseball bats. Whenever the government gets involved, it’s sure to be unpredictable and usually will end up being a disaster. It’s sad when you have to wonder from month to month if or when the little medication you’re being ALLOWED might be cut entirely. God help us all.

  • Anthony, it’s a lack of apathy from those who’ve never had to live with chronic pain every minute of every day. What we’re going to see, is what I call The Law of Unintended Consequences, and it comes into play whenever clueless lawmakers try to “fix” what they don’t understand. Yes, many people will resort to illegal and more dangerous drugs, taken with no physician’s supervision. Some will end up in prison, some will die from overdoses they’ll be more at risk of having, and some will simply put a final end to all their suffering. The media won’t report it, the Government won’t acknowledge it, and the so-called “War on Drugs” will grind on endlessly. I’ve been taking opiates out of necessity for 8 years now. It’s not the ideal solution, but I’ve never had a problem with them, because I use them as directed, and I fully understand the consequences if I didn’t. Apparently some people lack the self discipline to do that, but that problem needs to be addressed separately from the brute force approach being implemented now. I’m 70 years old. What difference does it really make if I have to take pills to manage the pain half a century of hard work caused me? I’m not trying to get high, I’m just doing my time like everybody else.

    • Yes, you hit the nail on the head. They have no empathy, because they’ve never experienced chronic pain. I’m so tired of being made to feel like a criminal drug addict every time I have to fill my medication. CVS takes the cake with their rude condescending looks and comments over the meds. There’s nothing like having what looks like a twelve year old counter boy judging something he can’t begin to understand. I would love to trade places with him…he can have my chronic condition and the meds to go with it. I’d like to meet up with him after a week of dealing with this pain. I can guarantee he wouldn’t have anymore snide comments. I left CVS for the above reasons and my new “small town” pharmacy didn’t have my medication this month, so they suggested I use CVS for this one prescription. I will never do that again! I will establish myself with another small pharmacy in the event I have to use a different pharmacy in the future. I won’t buy a pack of gum from CVS.

  • Thanks for that well thought-out critique, James… very helpful and full of insight. Were you on the debate team before you dropped out of school? Perhaps you was a English major?

  • Great news, Lance, and also great advice. The AMA is also getting involved with pharmacies misusing the new guidelines. There are just too many of us in an aging population, and we need to be heard. We simply are not in a position where we can just accept “no” for an answer and suffer every day.

    • I agree with you. I am starting to have problems getting my prescriptions on time and also the pharmacy not having enough of my medication on hand to fill it. I am 66 years old with severe arthritis and my stomach does not tolerate n saids of any type

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