Express Scripts to Limit Opioid Prescriptions to Curb Epidemic

Express Scripts, the nation’s largest pharmacy-benefit manager, is adjusting its opioid-management program to limit the amount and strength of opioid prescriptions for first-time users. The new policy is an effort to curb opioid misuse and abuse, but health-care providers and medical associations have criticized it.

The pilot program was launched in 2016 in response to the U.S. opioid epidemic, which was recently declared a national emergency and claimed more than 30,000 lives in 2016.

The program limits first-time opioid users to a seven-day prescription for short-acting drugs, and it prohibits longer-duration prescriptions and long-acting forms of the drug. Doctors will be able to request stronger prescriptions if they deem them necessary. The new policy does not apply to patients in hospice or palliative care or patients with cancer.

The company noted it also will watch for patterns of potential “pill shopping,” when a patient goes from doctor to doctor to collect prescriptions.

CVS Caremark, another pharmacy-benefit manager, has a similar program in place that limits first-time opioid prescriptions to 10 days.

However, the program has raised concerns from physicians and the American Medical Association (AMA) who believe treatment discussion and planning should remain between doctor and patient. Patrice Harris, MD, an Atlanta psychiatrist who chairs the AMA’s Opioid Task Force, told the Associated Press, “We want to be proactive in making sure the alternatives are available, versus a sort of blunt, one-size-fits-all approach regarding the number of prescriptions.” She also expressed concern that the  steps to request a larger supply of the medication create an additional administrative burden on the provider, and “more importantly, they delay care for the patient.”

The program will officially begin September 1 for Express Scripts members whose employers or insurers have opted into the program.

Source: Associated Press, August 16, 2017.