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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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    • You are not telling the truth. CVS does not sell tobacco.

      CVS should be commended for limiting the amounts of opioids that they sell. It would be easy for them to rake in profits by turning their customers into opium addicts, but CVS has chosen to do the responsible thing.

  • How does this affect chronic pain patients? I have degenerative disc dresse. I take prescribed pain meds (10yrs). Cvs stopped allowing me to use Blink to help me pay so After a 10yr relationship with cvs, I’m now at rite-aid. I always feel judged because I take pain meds. Now this makes me feel scared. Pain hurts.

  • I have a difficult time having for profit organizations making decisions about what medications a patient will receive. A provider (MD, NP, PA) and a patient need to make a decision about what the patient needs not Express Scripts or CVS pharmacy or other big name corporations. I understand the need to stem the opioid epidemic in this country. I work in the field at an outpatient Medication Assisted Treatment (MAT) center. Historically the pharmacies have made a huge profit from drugs. Why don’t they increase the cost of opioids triple digits percentages rather than cancer drugs or other high cost drugs. Insurance companies will definetly cut approval for high cost drugs. If we providers allow this to occur…what will happen in the future when a pharmacy or drug company wants to do something? Will they have carte blanc in making decisions about your health care in the future regarding medications?. I wonder? I think we are looking down a very slippery slope. I believe there are other ways to stem this opioid epidemic. Taking power away from patients and providers is not the way to solve an epidemic.

  • TR…
    Well-said!
    I don’t have to justify my medical conditions that require me to take pain meds, but I have been down every avenue, have had 9 back/neck surgeries and have a nerve stimulator implant in my back. I’ve been through it all, inc hundreds of injections and radio frequency ablation (burning of the nerves) and if I have to take a pain pill to have some semblance of a normal life, so be it. It’s not up to Pharmvet or anyone else to tell me what I need to do. I trust my surgeon and pain management Dr of many years, not a pharmacist and certainly not a chain store. Unless you’ve walked in my footsteps or of those who deal with severe chronic pain on a daily basis, your 2 cents is not welcome or called for.

  • D:

    Thanks for your comments. I was aware of rebound headaches that you can get from opiates and even from Excedrin Migraine too. Sometimes I just take Excedrin, but I’ve had them for so many years now that I can tell which med to take. I try not to take anything until I reach the point that I know it’s going to get out of control.

    I can’t do MJ. I stopped when I went in the military at 18. I tried it again at some point in my 30s and it made me feel terrible. It’s been 20 years since I last tried it. It’s not legal where I live and I’m subject to random drug testing too. I can have opiates in my system and pass because Surescripts reports the prescriptions, but weed is a no-go.

  • One of the contributing factors for CVS’s new restrictions on pain medication is the DEA. Two months ago CVS was sued by the DEA for millions of dollars for not complying to strict opiod policies. The DEA needs a renewed war on drugs and pharmacies can only oblige.

    • I just think this will make things even worse for a lot of folks,that actually need the medication. This will only fuel the Heroin pandemic i am afraid.

  • I do think our government is way too much business in our medical needs ,and now the pharmacies .Give me a break. People like myself, I get The Fentanyl Patch 75 every 3 days, and percocet 10/ 325 every 6 hours .That was taken from me only because I refused to have a foreign part put into my body. A machine attached to my spine in order to tell my brain I have no pain .Now I have no pain management, and no pain meds, until mid to end of October. It is really getting bad when the government has their nose in your medical business. Thanks to that goombi that is in office. I am pretty sure he gets his meds and whatever he needs in order to go on day-to-day. The very ones that are making the new rules and regulations in pain management are the very ones that are not and never will be in pain. They don’t know what pain is all about. This is a sad ,sad world when you have to go on the streets and order to be able to get through day-to-day life. Sad sad world !!!!!

    • I just think this will make things even worse for a lot of folks,that actually need the medication. This will only fuel the Heroin pandemic i am afraid.

    • David Holmes: By that “Goombi” in office, I am assuming you are referring to Mr. Trump. Myself and many others have been fighting all of these new goverment regulations since they began well over four years ago with the blessing of the “Goombi”, Mr. Obama, then in office. Again, we are rallying on the side of chronic pain patients who in far to many instances are being denied adequate pain relief.

      The FACT that you mentioned you go out on the streets for your supply of pain meds leads me to believe that your doctor may have suspicions that, or you came back dirty on a urine test and that has more to do with why your prescriptions were adjusted.

  • While these new guidelines by CVS may be for new patients, it’s not going to surprise me when they go after those with real, chronic pain. I don’t believe their plan is going to stop people from abusing opioids because they will find a way to get them, and the main reason they turn to heroin is because it’s cheaper and easier for them to get, anyway. I see my pain management Dr every 3 months and he writes out my prescriptions with a fill date on them. I also am randomly screened at my appointments to make sure I have the medication in my system and nothing I’m not supposed to have. In 20 years I have never failed or had any problems with these tests, nor have I ever asked for an early refill or run out of my meds. Those of us who take our meds responsibly are eventually going to be targeted once they figure out that their plan to save the world isn’t working and they have to do something else to save face or try to make the stockholders happy and to avoid any more lawsuits from people who became addicted. Doctors are going to get fed up with constant calls from CVS, questioning a prescription they’ve written and will eventually tell patients to stop using them; they didn’t go thru 8 years of medical school to be undermined or questioned by a pharmacy tech or pharmacist. We have 2 choices here, either use a different pharmacy (like I already do) and not give them our business (I doubt they’ll be getting very many new customers, especially if a Dr writes a script for more than 7 days) or you can tell them you support their decision and continue using them. They removed nicotine products from their stores and people just went elsewhere to purchase them, so this is no different. They didn’t stop the country from buying them. I, for one, will never step foot into another CVS because I do not support them and will hit them where it hurts in their bottom line.

    • I meant to add that they are still selling alcohol in their stores, so are they telling us it’s ok to drink, but don’t smoke or take pain meds because they’re bad for you? Maybe they should look up the effects of alcohol.

  • Jackie: my doctor and I have the same trust. His sponsoring hospital recently began requiring the signing of a pain management contract, maximum quantities (which are actually far greater than what I consume), and quarterly drug testing to see if other opiates or opioids are being used. I have been using Vicodin for migraine management for many years. I’ve never displayed any of the drug seeking behaviors with him, the sole pharmacy I use, or by attempting to obtain duplicate prescriptions from other doctors, and so on. While I have complied with the policies, my doctor trusts, based on my usage and behavior, that I am not at risk of overuse or addiction and has actually waived the quarterly drug test.

    I consider the medication a great thing because it allows me some amount of function for a migraine that may last for 48 hours. It keeps me from staying in bed, unable to sleep, and with a mask over my eyes to block out all light for all of those hours.

    It is honestly needed. I have tried most of the triptans to abort migraines which only works sometimes, and use Topamax, Inderal, and even Amitriptyline as migraine prophylaxis. All with little to no success.

    • Martin,
      Just fyi even though the opiates help your migraines, they overall increase migraines both in pain and frequency. I use opiates for spinal pain and chronic all over body pain. If i use too much in a week and then weeks in a row I automatically get severe migraines with all symptoms that last for several days. If I back off they improve. My neurologist told me to watch my opiate intake for that very reason: opiates increase migraines.
      So just be aware of that. It may help in the immediate but in the long run it may be increasing them in some way.
      Peace.
      Oh yeah if you’re not opposed to medical marijuana, I can’t stand the stuff but I’m sensitive to it. I know a guy who had SEVERE migraines, debilitating, non-speaking, passing out barfing migraines who was helped by marijuana. Sativa strain I think? My formula also helped him even though he continued the pot. Mine was meadowsweet and skullcap in alcohol tincture. It works well!!

    • Martin: Please know we are fighting to reinstate the rights of chronic pain sufferers. It breaks my heart to see people constantly having to legitimize their need for opioids.

      And, just because someone says you are in the wrong with your therapy because it doesn’t work for them and their doctor told them such and such, don’t listen to them. You also have a doctor and the therapy has been working for you.

      Good luck to you.

    • Reese59:

      Thank you for your well wishes to me.

      I know that opoids can be very dangerous if misused, but I am very thankful that there is a medication out there that allows me to be somewhat functional when a migraine strikes.

  • My husband has neropathy of the feet , he takes a mild opiate but one 30 day script he makes last for 3 months , he has proven he is not abusing.

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