With the 64,000 deaths from opioid overdoses last year alone, the medical community is struggling to contain the out-of-control opioid epidemic. Now, CVS, one the nation’s largest pharmacy benefit managers that oversees prescription drug benefits for 90 million people through its CVS Caremark plan, is attempting to address opioid abuse by no longer reimbursing opioid prescriptions beyond the first week for people filling these prescriptions for the first time.
Beginning in February, the company announced, it will adhere to the Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing opioids that limit doses and duration of the drugs prescribed by doctors. The CDC recommends prescribing the painkilling narcotics, which can be highly addictive, in as low a dose as possible for as short a time as needed. Not only will CVS Caremark only reimburse for seven days of prescriptions, but for first-time opioid prescription-fillers it will also dispense short-acting, rather than extended release, versions of the drugs for these patients.
The pharmacy benefit managers who authorize prescriptions for CVS Caremark plan members, as well as pharmacists at CVS retail pharmacies, will be spending more time explaining to patients and doctors why some of their opioid prescriptions won’t be filled as ordered. “We estimated how long it would take for these conversations, and we are staffing up to do that,” says Dr. Troyen Brennan, chief medical officer of CVS.
Here’s how the changes will work: If a patient has a prescription for several weeks’ worth of opioids and wants to fill the prescription for more than seven days, he will need pre-authorization for the drugs—obtained after the pharmacy benefit manager speaks to the prescribing doctor—and will have to pay for them out of pocket.
Pharmacists already call doctors when they have questions about the duration or appropriateness of medications to treat certain conditions, and Brennan says he anticipates more of those conversations will take place as doctors also make an effort to adjust their opioid prescribing practices to adhere to the CDC guidelines. “A lot of doctors are moving in the direction of the CDC guidelines and counseling patients along the same pathway,” he says. “What we see ourselves doing is reiterating that and doing our part.”
Brennan estimates that the new stricter dispensing policies will affect about 300,000 people who fill prescriptions through CVS. The company is also supporting community-based addiction programs and providing education to its clients about opioid addiction and the benefits of using the drugs in the lowest dose possible for as short a time as possible.