Healthcare News & Insights

Major pharmacy cuts off access to opioids for high-risk prescribers

Abuse of opioid prescription painkillers is the No. 2 cause of accidental death in the US.  And the problem is only getting worse. In 1999, the number of deaths due to overdose in the U.S. was 4,000. In 2010, it skyrocketed to 16,600. But one pharmacy is cracking down on doctors that overprescribe opioids and cutting them off.

121349418 CVS Caremark Corp.’s actions recently were revealed in an article on the New England Journal of Medicine‘s website.

Pharmacies’ responsibilities

As a pharmacy chain, CVS knew it was in a better position than individual pharmacies to take action against physicians who abuse their prescribing privileges of opioids.

Under the Controlled Substances Act, pharmacists are required to evaluate patients to ensure the appropriateness of any controlled-substance prescription. The state boards of pharmacy also regulates the distribution of opioid analgesics and other controlled substances through the discretion of pharmacists.

But with only a small amount of background information, an individual pharmacist has little he or she can do when a patient has a legal prescription from a licensed physician. Chain pharmacies, however, have  information on all prescriptions filled at the chain.

That’s why CVS stepped up and instituted a program that analyzed all the data and took action against overprescribers.

In a Reuters article, CVS’ Chief Medical Officer Troyen Brennan said, “This isn’t a definitive solution to the problem. We wanted to share what it was that we did and have other people in healthcare, including other pharmacies, look at what we did and discuss what some more comprehensive solutions might be.”

CVS’ program

To get that discussion going here’s a brief description of CVS’ analysis and action program:

Identify possible abusers — From a database of around a million, physicians and other prescribers who exhibited extreme patterns of use of “high-risk drugs” relative to other prescribers were identified. Data from submitted prescriptions from March 2010 through January 2012 for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol was examined and compared with others in the same geographic region and same listed specialty. Then the number of their patients who paid cash for high-risk–drug prescriptions and their ages were looked at. Finally, the prescriptions for noncontrolled substances were compared with the prescriptions for controlled substances within the prescriber’s practice.

Interview outliers — To minimize the possibility of cutting off prescribing privileges for prescribers who were appropriately treating patients, three letters requesting interviews for more detailed information about prescribing habits were sent to the 42 physicians flagged as outliers, and attempts were made to contact the outliers by phone. Six of the 42 could justify their high volume of prescriptions. However, after nine months of not filling their controlled-substance prescriptions for the remaining 36 outliers’ patients, only three have requested to be reinstated.

CVS noted in the New England Journal of Medicine article that its program is in no way comprehensive, but it gives insight as to what’s going on in the healthcare industry when it comes to inappropriate prescribing.

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