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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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  • Unfortunately, even Winn Dixie and many other pharmacies are following this example set by CVS. I went just this morning for a Tramadol prescription which I haven’t filled one in over a year. They would only give me 7 days. I have to go back in 7 days and get the next and so on. Fortunately for me, it’s not Vicodin or one of those. They aren’t allowed to “hold” the rest of the prescription and the patient would be forced to go back to the doctor for another prescription in a week. For me, that would mean a $50 copay at my primary care or $100 copay at my specialist’s office. That’s just insane and just will not work.

  • I have been taking opiates for many years. It has provided me the ability to work and support my family. If Scott’s crazy plan is passed, I will be admitted to the hospital for sure to battle withdrawal plus require the hospital to ease my pain. If not I will probably die. And I will have the total outrageous bill sent to Scott to pay.

    • I stopped shopping at CVS 3.5 years ago after being treated like degenerated druggie when trying to fill my prescriptions for morphine and dilauded. I have Stage 4 bone and lung cancer and have terrible pain.
      However, my insurance company contracts w/CVS but they allow me to fill RX @ Walgreens, where they treat me half as bad….

  • Beware that existing chronic pain sufferers that take opiods cannot simply be cut off. Chaos will follow. Gov Scott is very misinformed about those of us that need opiods to get by and overcome severe chronic pain. Go after the crooks not the decent people.

  • I’ve been on opiate therapy for 10 years. I do not get high – couldn’t even if I tried, even if I took a fistful of my pills! I am not addicted, I do not share or sell my pills, I do not abuse my pills, I do not seek more pills from additional Drs, and I’ve never embellished my pain issues to get more pills. I am a legitimate chronic pain sufferer on the cusp of my 3rd spine surgery and 2 knee surgeries, suffering from rapid degenerative processes that are occurring at a rate of 1/4″ of height every year. I am literally shrinking before your eyes. My body is crumbling. I can’t climb up or down stairs because I have no trace of cartilage in my knees. I have a constellation of issues with my spine and the nerves that innervate my legs. Without my medicine, the pain is too great to bear. I cannot sit, stand, lie down, or any combination thereof. I can’t sleep. NOTHING helps – not baths, heating pads, or any amount of over the counter medication. Before opiate pain mgmt therapy, I was taking up to 24 Advil a day and ultimately got gastritis. Tylenol did nothing at all for me. Even Tramadol was a joke! But still, I swallowed 6/4/6 of those three medications, respectively, and I’d often do it twice a day with zero relief. And, most scary is that I’m now a post M.I. heart patient who isn’t supposed to be taking NSAIDS at all. So that leaves me with 3 Tylenol a day as my only option since more would damage the liver? For pain that is so severe, so intractable, so penetrating, so widespread, so sharp, so exhausting that it will cause me to be suicidal when the day comes that my opiate medication is taken from me by the DEA?!

    The govt is KILLING chronic pain patients, and we are starting to wonder if they are doing it on purpose. We don’t have any other explanation as to why they are attacking and punishing us when we aren’t the problem, we aren’t the addicts, we aren’t the criminals. It makes no sense! It’s like trying to curb epidemic alcoholism by taking wine away from the churches who serve it with Communion.

    Doctors are supposed to HELP sick people. Not injure them or make them sicker by refusing to treat them with the most effective, least risky – yes, LEAST – treatment available, which is doctor-monitored opiate therapy. By taking away the medicine we need to be able to work, to care for our families, to function at all, they are forcing us to commit suicide, go into the streets to find heroin which is infinitely more dangerous, or live our lives in bed in tears wishing we would die. It’s unthinkable that this is happening in America and the West. It’s ABUSIVE. Actually, it’s beyond abusive, it’s torture. It’s Medical Terrorism! It borders on genocide….the extermination of people with chronic disease. And it MUST BE STOPPED!

    • I hope you can find relief. My issues (migraine) as not as nearly as chronic as yours, though I have suffered from debilitating migraines for >13 years. I have had a hard time lately with my doctors sponsoring hospital changing policies.

      I have had luck by finding a physician who will execute a pain management contract with me, which lays out the terms and conditions of managing chronic pain. I was good with it, as it provides me with the relief I need to remain functional and my prescriptions are under the maximum allowed under by the standard pain management contract. You may find a physician who will treat you equitably by first mentioning a pain management contract, which are widely used these days. Good luck to you.

    • I feel the same AJ. I’ve had fibromialgia for many years. Along with that are so many others sister problems as they call it go with it. Such as RLS,migraines, fatigue, low or no immune system. In my case I can not walk without opiods. The only way I can discribe it is like you take a doll and wind her legs till they break! It’s awful! I wouldn’t wish what is wrong with me on no one. But I’ve thought the same as you…it feels like genacide. So many in pain like us will choose drastic measures if they take our medication away. I’m not an addict either. I don’t see how im gonna survive without my meds…it would mean torture…I would rather die than live in that pain.

  • I’ve been taking Vicodin for 20 years. After the first 10 I stopped for a year. Wanted to prove to everyone & myself I take them only for pain. During that year I used Alieve. Didn’t work & caused big problems for my stomach. Chronic pain users don’t usually feel high from Opiates. We take them for pain. The government should not be in our business relating to medical issues. I won’t shop at CVS ever again. Several years ago I got my prescriptions through them. I didn’t have health insurance for 3 years. They were charging me over $100 for a months supply of Lexapro. I left & used Costco. The price was around $7. I moved the rest of my medications there also. I was taking Topamax & CVS was charging me like $300 a month. Again Costco was so much cheaper. Now with what CVS is doing I wouldn’t buy a bag of M & M’s from them. I’m not an addict. My doctor of twenty years agrees with me. When tapering off medications it must be done very slowly. I’ve done it with many drugs over the years. I live in California & medical marijuana is legal. I’m considering trying the edibles. I wouldn’t care to smoke it. Apparently from what I’ve read it can work as well as Vicodin. I will have to see how much it costs. I hear it’s expensive. The THC is removed from it so you don’t get high. Chronic pain sucks & we shouldn’t be made to feel uncomfortable because of the type of medications we take to live a halfway decent life….

    • There are plenty of independent pharmacies out there that will fill for you, including the Kroger branded groceries (Vons on the west coast.) They will just want to get the paperwork correct in case the DEA audits them.

      GoodRx is an online tool which I have used to save a lot of money on all of my prescriptions since I don’t have insurance. Go there online, it is really simple to create an account, and then search on the medications you take, include the dosage and number of pills you take each month, and then it will create a coupon for you to print out.

      Topamax in my market with Vons with a GoodRx coupon, for instance, is only a little over $12. The cash price at CVS is $186, so GoodRX, used at the cheapest source can be a significant savings.

      Best of Luck, B

    • I have no choice but to go to CVS for my meds. I didn’t add that iny above comment. CVS is the only drugstore my insurance allows to go too

  • I have suffered through major depression and Generalized Anxiety Disorder. I questioned my psychiatrist when he prescribed Ativan (know to some as Lorazepam). He said that at that point an addiction was the least of my worries. Now, 4 years later, I have made the decision to quit taking the drug. My psychiatrist prescribed Valium (which has a longer half-live) at an equivalent of 14% of the dose of Ativan I was taking. The withdraw symptoms were nothing short of profound. I did not sleep, nor did I eat for days, along with a dozen other substantial withdraw symptoms.

    I did, fortunately, find a local addiction specialist who is working with me on a much slower taper, and I am very happy to say that the only withdraw symptom comes about once a week in the form of insomnia.

    If your doctor has cut you off abruptly, I would encourage you to find an addiction specialist (certifications are DABAM & FASAM) who will help you withdraw properly with a minimum of symptoms.

  • My doctor, whom I’ve been seeing for years, is already afraid to treat my pain more aggressively. He is a pain doctor and was afraid to give me a replacement med for one that works but the ins won’t cover. I was nearly in tears. Without pain medication I can’t physically handle the pain enough to even leave my bed. I have always been in compliance, I’ve suffered thru shortages, formulary changes done with no notice, cancelled doctors appts without ever once doing an illegal drug to manage thru the withdrawals. I don’t take pain meds for ‘fun’ or because my life is a wreck. I take them so I can get dressed everyday, feed myself, clean myself without assistance. Spend time with my grandson, my son, my husband. I don’t leave the house much anymore because of my health issues. I didn’t ask for this, don’t want it, but now to be made to suffer for others wrongs? So many of us will be suffering. And this will, in the end, create more heroin addicts, not less. The real issue? It’s doctors ignoring the fact that after a certain length of time their patients will become physically dependent on the medication. Some will also become emotionally dependent. When we start getting real about that fact and start to act accordingly will be when we start to see this epidemic come to an end. There needs to be a system where patients and prescribers are not punished when a patient gets into trouble with addiction. Or when a patient decides their pain treatment should end but they now have the monkey of physical dependence to conquer. Pain prescribers cut those patients off cold without ever assisting them to stop for fear the patient will cost them their livelihoods. The patient will have to find a way to either soothe their withdrawal ssymptoms on their own then, or go thru a dangerous withdrawal alone. Boom, you’ve created a heroin addict. Punishing people like me who just want to retain some semblance of a normal life isn’t the way and it is cruel. The kind of pain I know I endure, I don’t believe I will be able to tolerate it. And I won’t put my loved ones thru it, either. Knee jerk reactions like this never end well and how long before we start to hear about people killing themselves to escape the severe pain they couldn’t get treated? I expect it won’t be too long. I know I will be avoiding surgeries knowing my pain won’t be handled well. And god forbid something happens where my pain increases. I’m scared. I’m really scared.

    • I have suffered through major depression and Generalized Anxiety Disorder. I questioned my psychiatrist when he prescribed Ativan (known to some as Lorazepam). He said that at that point an addiction was the least of my worries. Now, 4 years later, I have made the decision to quit taking the drug. My psychiatrist prescribed Valium (which has a longer half-live) at an equivalent of 14% of the dose of Ativan I was taking, along with a 4-week tapering dosage. This is way too fast and there is no way I could remain functional. The withdraw symptoms were nothing short of profound. I did not sleep, nor did I eat for days, along with a dozen other substantial withdraw symptoms.

      I did, fortunately, find a local addiction specialist who is working with me on a much slower taper, and I am very happy to say that I am down to half of my original dose and the only withdraw symptom comes about once a week in the form of insomnia.

      If your doctor has cut you off abruptly, I would encourage you to find an addiction specialist (certifications are DABAM & FASAM) who will help you withdraw properly with a minimum of symptoms.

    • I should also add that addiction specialists (at least mine has said) that he treats far more opoid/opiate users than any other type of drug.

      Do NOT be afraid to seek a specialist or feel humiliated by doing so, I had taken my Benzodiazepine medication as prescribed for the entire duration I used it too.

    • Dear Anonymous,

      I’m so sorry you’re going through all this. I am in a somewhat similar situation, and I’m scared, too. My pain doctor is thinking about retiring, even though he’s much too young, because he is terrified by all the new and tightening regulations. I just wanted to “ditto” two of your comments: 1) I ask the same question–why should I suffer because others have done wrong? and 2) People are already killing themselves to escape pain for which they can’t find help. I know one of them personally. He could not find a doctor to trust him and work with him to really manage the terrible pain of severe spinal arthritis.

  • CVS bottom line you don’t care about the opioid issue, you’re changing your policy so you can make more money from it. Working in the medical field I have already taken liberty of informing my clients to stay away from your pharmacy. Just doing my part to be sure my clients needs are being met in a responsible and compassionate way.

    • How does one “stay away” from their pharmacy? I don’t agree with what CVS is doing with their policies, but I use more than one controlled substance and have never had a problem because I always use the same pharmacy and all of the pharmacists and pham techs know who I am.

    • Maybe you are saying stay away from CVS?

      Of the troubles I’ve had with any pharmacy, Walgreen’s has been the worst.

  • Properly and appropriately prescribed, legitimate patients taking opiates very seldom become psychologically addicted. Patients inclined to addiction will become so no matter what CVS does. The problem occurs when large numbers of opiates are prescribed for very short term pain such as tooth extraction, broken bones and other minor wounds. As others have mentioned, CVS is hypocritical in that they continue to profit from tobacco addiction.

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