Comprehensive Response to National Opioid Abuse Epidemic

It is well known that the human and economic costs of widespread prescription opioid abuse are profound. The U.S. accounts for 80 percent of the world’s consumption of opioid painkillers and 99 percent of hydrocodone.

CVS Health is committed to partnering with clients, health care providers, government agencies and pharmaceutical companies to help address the opioid crisis.

As part of its broad commitment to fighting the national opioid abuse epidemic, CVS Health is enhancing its enterprise-wide initiatives supporting utilization management of pain medications, safe drug disposal, and funding for treatment and recovery programs. This effort will leverage the capabilities of CVS Health's pharmacy benefit manager (PBM), CVS Caremark, which covers nearly 90 million plan members, and the CVS Pharmacy retail presence in nearly 10,000 communities across the country.

This expansion of our industry-leading initiatives includes a strengthened utilization management (UM) program to encourage clinically appropriate use, greater pharmacist counseling for patients filling an opioid prescription for the first time, and an expansion of its drug disposal collection program at CVS Pharmacy locations. In addition, the CVS Health Foundation will also be expanding its community education and support programs.

Strengthened Utilization Management Program

Our standard opioid management program will be aligned with the Guideline for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and Prevention (CDC) in March 2016. The enhancement is designed to positively influence the prescribing and use of opioids to treat pain. It complements measures already in place for clients, including ongoing monitoring for patterns of inappropriate prescribing or use, and controls such as drug utilization review. Beginning in 2018, all clients will be transitioned to an opioid management program based on morphine milligram equivalents — or MMEs — a measure of the number of equivalent milligrams of morphine a drug contains, an approach supported by the CDC Guideline.

Balancing Risk and Access

Opioid painkillers provide needed relief to those with acute or chronic pain. But given their potential for harm and the very real — and pervasive — problem of misuse and abuse, helping ensure appropriate use is more critical now than ever before. The CDC Guideline, as well as other medical organizations such as the American College of Physicians, emphasizes the need to consider other means of treating chronic pain — other than chronic pain from cancer treatment, palliative care or end-of-life care — before turning to opioids.

The underlying principles of the CDC Guideline include using the lowest possible dose of opioids for the shortest possible duration, and ongoing monitoring by a physician to assess whether the benefits outweigh the risk of abuse, addiction and dependence.

In February, we announced two UM options to help encourage appropriate opioid use by patients and providers.

Aligned with CDC Guideline

Effective February 1, 2018, all commercial, health plan, employer and Medicaid clients will transition to the enhanced MME-based management program unless they choose to opt-out. For clients who choose not to align with this strategy, the label-based approach will continue to be available to help manage opioid use among their plan members. For clients using the Standard Exchange Formulary, the change will be effective January 1, 2018. If clients choose not to implement the MME-based program, they will need to use a custom formulary.

Our enhanced MME-based UM program will:

	Limit Days’ Supply The length of the first fill will be limited to seven days (when appropriate) for new, acute prescriptions for members who do not have a history of prior opioid use, based on their prescription claims. A physician can submit a prior authorization (PA) request if the patient needs to exceed the seven-day limit.
	Limit Quantity of Opioids The quantity of opioid products prescribed (including those that are combined with acetaminophen, ibuprofen or aspirin) will be limited to 90 MME per day. Prescribers who believe a patient should exceed CDC Guideline recommendations can submit a PA request for up to 200 MME per day. Quantities higher than that would require an appeal. Products containing acetaminophen, aspirin, or ibuprofen will be limited to 4 grams of acetaminophen or aspirin, and 3.2 grams of ibuprofen per day.
	Require Step Therapy Use of an immediate-release (IR) formulation will be required before moving to an extended-release (ER) formulation, unless the member has a previous claim for an IR or ER product, or the prescriber submits a PA.

Enterprise-wide Measures

We continue to build on ongoing efforts to help reduce opioid abuse, such as prevention education and proper medication disposal, providing increased access to the opioid-overdose reversal medication naloxone in 43 states, and ongoing advocacy to improve tools like Prescription Drug Monitoring Programs, which help pharmacies and prescribers prevent abuse.

Without a doubt, addressing our nation’s opioid crisis calls for a multipronged effort involving many health care stakeholders – from physicians to pharmaceutical companies, and pharmacies to government officials. With the implementation of the MME-based management program, and the launch of an enterprise-wide campaign to reduce unnecessary opioid prescribing and use, we are further strengthening our commitment to helping our clients and their members balance the need for these powerful medications with the risk of abuse and misuse.