Prescription safety management

CVS Health has made an enterprise-wide commitment to help address the abuse and misuse of prescription opioids. For plan sponsors looking to manage utilization, we offer a range of utilization management (UM) strategies. Our UM approach for opioids is informed by the Guideline for Prescribing Opioids for Chronic Pain from the Centers for Disease Control and Prevention.

To further enhance safe prescribing across all types of medications, we have developed a Prescription Safety Management solution. The program comprises a set of dynamic strategies to help reduce inappropriate use without restricting access for those with legitimate need. Our Prescription Safety Management program is informed by best practices, learned from our UM strategies for opioids, including preventive measures such as duplicate therapy and drug interaction alerts.

Opioid management results for CVS Caremark clients since Q1 2017:

• 42% drop in total number of opioid Rxs
• ~50% drop in dispensing of opioid Rxs for >7 days
• 15% decrease in morphine milligram equivalents (MME) per day per Rx
• 49% decline in extended release opioid Rxs

In 2019:

• ~89% of acute Rxs were for 7 days or less
• ~99% were for 90 MME per day or less

Oversight, Management of Each Step of the Member Journey

Based on four key pillars, the Prescription Safety Management solution provides management and safety oversight at all points of the member journey. The program is designed to help enhance safe prescribing including at the point of dispensing, and retrospective analysis of utilization.

Key Pillars of Prescription Safety Management:

• Prevention Utilization and safety checks and messaging at the point of sale, including duplicate therapy, drug interaction, age/gender, and possible pregnancy alerts.
• Identification Dynamic surveillance to help identify and assess potentially higher-risk members based on multiple factors.
• Intervention Targeted communication to prescribers, members, and pharmacies to address unusual medication utilization patterns.
• Investigation Extensive research with a detailed course of action for more complex member utilization patterns.

All the components work together to help resolve unusual prescribing patterns that may be a potential member safety issue. As we collect additional data and refine best practices, we will continue to enhance Prescription Safety Management with new interventions to help address changing clinical evidence guidelines and client needs.

Data source, unless noted otherwise, CVS Health Enterprise Analytics, 2020.

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