The new CVS opioid to OTC thing

[owlegrad]

Druggies have many resources available like MAT should they avail themselves of them and many illegitimate resources so that they don't waste time going to the dentist for #10 to #21 Norco if they do not care about dying. Also pharmacists do counseling, which sometimes involves the discussion of risks of medications.

Obviously no script is being changed. The "obstruction" part is specific to California where pharmacies and PICs can get cited for untimely refill authorization requests and delayed drug deliveries. CVS's PR stunt is limp-wristed B.S. like W's 2020 e-script ONRY policy.

Interesting way to not answer my question at all lol

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[owlegrad]

IF (world's largest if) CVS had allocated resources for this extra clinical work (which they certainly won't) this would be great. I see no problem with this as a policy.

There is no medicine being practiced here. The prescription is not changed (OTC's are being dispensed as OTC's not as a replacement for the Rx). No refusal is being made. This isn't obstruction. Our BOP would LOVE this policy.

I mean it’s a nice idea and CVS giving away medications to try to help prevent addiction seems like it would make a nice sound bite but ultimately I think I agree with you. It’s just another metric for CVS to harp on I am sure.

Not to mention like others are saying does it even make sense to crack down on dentists? Probably not.

 

[Sine Cura]

How many pharmacists do you know would rather go with the "we don't have it in stock" excuse or "we have to verify the prescription" instead of just outright telling people they're a dope fiend and need intervention?

 

[KidPharmD]

I mean it’s a nice idea and CVS giving away medications to try to help prevent addiction seems like it would make a nice sound bite but ultimately I think I agree with you. It’s just another metric for CVS to harp on I am sure.

Not to mention like others are saying does it even make sense to crack down on dentists? Probably not.

I don't think it is necessarily about cracking down on dentists as much as dental prescriptions are low hanging fruit. A lot of dental pain is treatable by NSAIDS or tylenol so it is an easy way to identify which patients might benefit from this kind of intervention. I don't really see this as punishing the dentists, but the free NSAIDs/APAP takes away one of the barriers that many patients have to trying something else first (many times the oxy's are cheaper). I understand that many dentists write narcotics at the visit because they don't know how much pain the patient will have and have no really good way of providing that script after hours or on the weekend. I just wish they would go on and write for some prescription NSAID (to keep it covered) as well and provide good instructions.

How many pharmacists do you know would rather go with the "we don't have it in stock" excuse or "we have to verify the prescription" instead of just outright telling people they're a dope fiend and need intervention?

I don't think this policy is about patients needing intervention. I think (if you view it in it's best light) it is about reducing the number of unneeded and unused opiates in the hands of patients who could be treated with Advil. I know I got Mepergan (it was still a thing then) when I got my wisdom teeth out. I took 1 because I thought I was supposed to, slept for the whole day and went to taking Advil. I had 19 of them in my cabinet for a while because I didn't know what to do with them.

Also, the "we don't have it" excuse is stupid.

 

[BidingMyTime]

Here's the thing, I think all of this clamping down on opioids is going to backfire. I think it will make people more likely to hoard their expired opioids, and more likely to ask for and to fill RX's they don't need. People already are afraid of pain and not being able to get adequate pain medication, the more opioids are clamped down on, the more fear people will have, and the more hoarding will happen (and the more hoarding that happens, the more likely for an addict to find that person's stash and overdose.) Cracking down, on for all intents and purposes, inconsequential dental RX's, will further promote the idea to people that these medicines are extremely valuable so they better stock up on them.

And I have to question, is this all just a revenue fund for the DEA, going after small-time prescribers, pharmacies, and dentists, instead of going after the big prescribers? Every state, sans MO, has a PMP, it should be extremely easy for the DEA to see who the problem prescribers are, and to go after the actual problem prescribers, yet this seems to be seldom done.

 

[genesis09]

Wisconsin actually did use the PDMP to determine the outliers. If they couldn't determine a true reason for them to be outliers, the state sent them letters warning them.

 

[KidPharmD]

Here's the thing, I think all of this clamping down on opioids is going to backfire. I think it will make people more likely to hoard their expired opioids, and more likely to ask for and to fill RX's they don't need. People already are afraid of pain and not being able to get adequate pain medication, the more opioids are clamped down on, the more fear people will have, and the more hoarding will happen (and the more hoarding that happens, the more likely for an addict to find that person's stash and overdose.) Cracking down, on for all intents and purposes, inconsequential dental RX's, will further promote the idea to people that these medicines are extremely valuable so they better stock up on them.

And I have to question, is this all just a revenue fund for the DEA, going after small-time prescribers, pharmacies, and dentists, instead of going after the big prescribers? Every state, sans MO, has a PMP, it should be extremely easy for the DEA to see who the problem prescribers are, and to go after the actual problem prescribers, yet this seems to be seldom done.

I don't see how this policy is "cracking down." Patient's can still have their Rx filled, they can still come back and get them filled later. The dentists don't have to allow them to be canceled at 7 days. I think the problem is that all of these dental Rx's don't add up to an inconsequential amount. I would be that dental prescriptions are responsible for a large amount of unused opioids in people's medicine cabinets.

Also how would this be a revenue fund for the DEA? I have never seen the DEA. Fines are usually paid to the prosecuting court (which does not go directly to the DEA). DEA issued fines usually seem to be for much more minor things (like forgetting to renew a number).

 

[RxPreceptor]

Uh huh...for anyone who has done the training module, what's to say stop people from scamming from free Tylenol + Motrin kits? Declining, then returning before the 7 day period to fill said opioid?

Seems like some overkill & just wrong targeting Dentists and a LOT of extra work/tedium in button mashing, designating extra space for designated products in an already cramped pharmacy, and more inventory (anal) management (OTCs FFS, now we have to keep specific sizes and BRANDS in a designated area). I think a lot of us are pretty adamant about counseling on reserving opioids for BTP/only PRN and asking about using IBU and/or APAP on the side already

 

[firework]

I welcome anything that would potentially demand more pharmacist labor hours, especially if it's clinical oriented. Fill a prescription without asking questions takes how many minutes? v.s. offering alternatives, putting on hold, calling office, deactivating old Rx, explaining to patient, etc.

 

[owlegrad]

I welcome anything that would potentially demand more pharmacist labor hours, especially if it's clinical oriented. Fill a prescription without asking questions takes how many minutes? v.s. offering alternatives, putting on hold, calling office, deactivating old Rx, explaining to patient, etc.

Yes I am sure CVS will be allocating more RPh hours for this.

 

[firework]

Yes I am sure CVS will be allocating more RPh hours for this.

So, you are telling CVS we want to be paid 6 figures but we won't do clinical interventions because you keep us busy counting pills. Be careful, over time, people may forget and think you don't want to do it or you can't do it, and they won't ask again.

 

[RxPreceptor]

So, you are telling CVS we want to be paid 6 figures but we won't do clinical interventions because you keep us busy counting pills. Be careful, over time, people may forget and think you don't want to do it or you can't do it, and they won't ask again.

Interpreted as corporate run chains wanting RPh always to somehow continuously do more with the same amount of resources

 

[owlegrad]

So, you are telling CVS we want to be paid 6 figures but we won't do clinical interventions because you keep us busy counting pills. Be careful, over time, people may forget and think you don't want to do it or you can't do it, and they won't ask again.

Please sir, may I have another?

 

[WVUPharm2007]

So i actually did this last night. The patient just had dental surgery. They looked at me like i had 2 heads. They took the opioid.

 

[radio frequency]

Wisconsin actually did use the PDMP to determine the outliers. If they couldn't determine a true reason for them to be outliers, the state sent them letters warning them.

Dang. Fancy footwork. Wish my state would do this. Or, alternatively, just ask the pharmacists. We all know the local general practitioners who have no business overprescribing opioids but constantly do. I could name names today if needed (don’t worry, there’s really only about 3, and their prescribing is constantly terrible) and I bet a lot of others could too.

 

[radio frequency]

So i actually did this last night. The patient just had dental surgery. They looked at me like i had 2 heads. They took the opioid.

If they had legit dental surgery, like impacted wisdom teeth, I’d probably just let it slide. It’s the opioid Rxs for drilling a crown or getting a cavity drilled that seem especially unreasonable to me.

 

[Sine Cura]

Would you legit do this for people with 8+ pulled teeth?

 

[WVUPharm2007]

And another thing, they expect you to have a conversation with a person that just had their mouth lacerated to hell and back. They just mumble in an angry tone and you get the drift. Yes, they would prefer the opioid.

 

[firework]

Would you legit do this for people with 8+ pulled teeth?

They never pull 8 teeth in one visit.

 

[jack_hen]

So what's everyone's opinion on this? This is sure to piss the everloving hell out of dentists everywhere. I feel like we are overstepping. Though I can see where CVS is coming from considering the legal atmosphere right now.

For non CVS workers, they are making pharmacists intervene on ALL opioid scripts from dentists. If we get an Rx from a dentist for an opioid, we have to offer to give the patient free Tylenol and Advil, put the Rx on hold, and tell the patient that opioid therapy as first line therapy is against ADA guidelines. And if the Rx is on hold for more than 7 days, you have to call the dentist to confirm the patient still needs it.

I anticipate a **** show.

This is CVS policy for all pharmacists from all states or only apply to certain states?? I am not aware of this. lol

 

[Sine Cura]

They never pull 8 teeth in one visit.

LOL