CVS Health Increases Restrictions On Opioids

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
This is very similar to the new Ohio law I posted about earlier. I'm ok with this.
 
I hope CVS Caremark is more intelligent than Express Scripts in regard to identifying "initial" therapy. Express Scripts imposed a blanket restriction on day supply independent of prior claims and it's a wonder when faced with a little resistance prescribers decline to do any prior authorizations for their own prescriptions. You'd be surprised how many people on Medicaid are willing to pay cash (or maybe not surprised).
 
First fill opioid limit is actually 7 days here in NY and 5 days in NJ.
Does not affect many scripts filled from the ER

Recent one I had though: Oxy/APAP #120 T PO Q6H PRN, checked PMP statewide surprised to find no Hx of opioid use. MD must have been living in a cave the last decade or recently moved from out of state
 
hopefully Walgreens will remain at the corner of happy (with) drug abuse, rather than at the corner of healthy..... i'm gonna send them all to y'all..
 
Good job CVS, I see the more important part of this restriction being the limit in morphine equivalents, so many people with "back pain" are already double or triple the CDC recommended max of 90 per day. I do think people have the right to do whatever harm to their bodies that they wish (as long as I don't have to pay for the medical care), but I really don't want to be the person handing out the bullets.
 
How is this going to work and kept track of?
 
BidingMyTime said:
It sounds like it's CVS's managed care plans, not their pharmacy in general.

Is that correct WVUPharm2007?
Click to expand...

I get the impression that it will affect the retail pharmacy unit as well. But I have no idea, they announce **** to the media before they feel like telling us or asking our opinions about things.
 
WVUPharm2007 said:
I get the impression that it will affect the retail pharmacy unit as well. But I have no idea, they announce **** to the media before they feel like telling us or asking our opinions about things.
Click to expand...

Yeah shouldn't the people working in the company should know about it first beforehand?

I still wonder how it will work though.
What if someone was discharge after a huge surgery and picked up medication locally where the facility was at.
Then went home to a different pharmacy for the next fill with a large quantity of script but would be denied the full amount?
What if people are switching pharmacy. And maybe CURES had not updated it?
Came from a different state with your state CURES show no history of it?



Wonder if Walgreen will follow with this limitation as well.
 
KimChiSlap said:
How is this going to work and kept track of?
Click to expand...

The 7 day limit will only apply to 1st time short term need (dental or ER scripts). Won't be an issue b/c most of those scripts are less than 7 days anyways. I assume they will be able to track first-fillers to differentiate "new" vs "chronic."

Otherwise, it won't affect people who have take pain meds on a monthly basis. It will go through just fine.

That's not the case for Express Scripts though.
 
Affects patients with caremark insurance regardless of pharmacy, however they can opt out of the 7 day limit by calling.
 
WVUPharm2007 said:
Everyone's favorite junkie forum reacts:
Link 1
Link 2
Click to expand...

Hahahahah

My pain management doctor HATES pharmacists. And you are totally right. Pharmacists are the biggest wanna be doctors I've ever seen. I have multiple issues including sciatica, hip arthritis, cystic ovaries and I'm on the list because I've had both kidneys removed. The pharmacy wouldn't fill my prescription because I had too many "codes" (the numbers identifying each problem). He said I had to be lying. Umm, I've had about a billion scans and it's pretty hard to make this stuff up. And, oh. My doctor said so. Geez.
Click to expand...
 
CetiAlphaFive said:
Hahahahah
Click to expand...

I saw that about the kidneys. I had an urge to reply to said comment but restraint was applied. You can't live without kidneys.

One of our local candy docs was just blackballed from Walgreens and so, their patients go from pharmacy to pharmacy trying to fill their rx. It's very annoying.
 
How do chains blackball prescribers with active licenses without facing litigation? Walmart literally "blocks" prescribers' scripts once they have lost their license 6-9 months prior... way to take a tough stand

Another example, this guy tried to sue CVS but it took Walmart until 2017 to "block" all his scripts as he no longer has a license in Wyoming

KAHN v. ARIZONA CVS, et al
Registrant Actions - 2017 - Shakeel A. Kahn, M.D.; Decision and Order

This guy reported would write for 360 oxycodone 30 and such so I suppose that's what it takes to lose your license. Keep it at 180 or less next time
 
Last edited:
Sine Cura said:
How do chains blackball prescribers with active licenses without facing litigation? Walmart literally "blocks" prescribers' scripts once they have lost their license 6-9 months prior... way to take a tough stand

Another example, this guy tried to sue CVS but it took Walmart until 2017 to "block" all his scripts as he no longer has a license in Wyoming

KAHN v. ARIZONA CVS, et al
Registrant Actions - 2017 - Shakeel A. Kahn, M.D.; Decision and Order

This guy reported would write for 360 oxycodone 30 and such so I suppose that's what it takes to lose your license. Keep it at 180 or less next time
Click to expand...
At Wal-Mart you just email someone at home office, and I guess they look into it.

This happened in a major Texas City to a candy man mid-level and he threatened to sue /report pharmacists to the board.

Furthermore, there's pretty clear case law on this subject.
 
Last edited:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
 
genesis09 said:
I saw that about the kidneys. I had an urge to reply to said comment but restraint was applied. You can't live without kidneys.
Click to expand...
It didn't say both were removed simultaneously. They could have lost one, got a transplant, and then lost the other.





They didn't, but could have.
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

Hahahhahha, corporate, or am overzealous district manager?

I'd ask to see the communication from the BoP or the laws they're referencing.
 
I severely doubt that a major corporate retail pharmacy would send out something like that. Compelling the pharmacist to fill prescriptions against their best judgement in any case is pretty big no no from the eyes of the DEA.
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

Post the email! I am sure we would love to see this brilliant, well-thought out plan.
 
zelman said:
It didn't say both were removed simultaneously. They could have lost one, got a transplant, and then lost the other.





They didn't, but could have.
Click to expand...
Removed, though? When was the last time you heard of someone getting a kidney removed that wasn't from renal cancer? They don't even remove them when you get a transplant - they just attach the new one right next to it.
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

Didn't think so much BS could be condensed into only 3 bullet points...
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

Honestly, you need to forward that directly to your board of pharmacy.
 
owlegrad said:
Post the email! I am sure we would love to see this brilliant, well-thought out plan.
Click to expand...

It was actually a picture of the email with the sender’s info cut out (my manager texted it to me). Lol I don’t want to post it and get in trouble... or would I get in trouble for it?
 
wucool33 said:
It was actually a picture of the email with the sender’s info cut out (my manager texted it to me). Lol I don’t want to post it and get in trouble... or would I get in trouble for it?
Click to expand...
Send them back a photo of an email with the sender's info cut out that says you should get a raise and double PTO.
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

I'm just surprised they didn't include a bullet point to find the cheapest discount card possible for said drug and/or manufacturer of choice...
 
wucool33 said:
Just received a corporate e-mail basically stating the following 3 points. Let me know how you guys feel about them:

1) If we don’t have a control in stock, it’s our responsibility to find it for the patient. We HAVE to call around until we find a place that has it (this is from BOP according to corporate).

Who does this for everyone?!

2) Pt/MD is out of the area is not a valid reason to deny fill and we will get in trouble with BOP.

I know a lot Rph has used this reason.

3) If a pt has been on a control for a period of time and all of a sudden a RPH doesn’t feel comfortable filling it anymore, then that RPH is liable for any withdrawal/harm caused to the pt.

So are they saying if an old RPH didn’t do his due diligence and kept filling for a pt and then retires, a new RPH has to continue filling it?!
Click to expand...

i still haven't come across this email. it must be your district only. and your district manager is a *****. this is not from corporate.
 
wucool33 said:
I feel so dirty when you reply to me...
Click to expand...

Opioid abuse along with billing frauds are dirty parts of pharmacy, and are widespread. if u participate in it, then u should feel that way.
 
The max 7 day supply was a pain in the ass for our pain patients on CVS managed medicaid plans. There are people who have been on the same dose for a year, and then they switch from something like Healthfirst CVS to Fidelis CVS and all of a sudden I'm getting a max 7 day supply rejection because the rx history didn't port over from the old plan to the new plan.
 
You must log in or register to reply here.

Similar threads

WildWing
[Announcement] CVS Health / AACP Community Pharmacy Health Equity Award for Student Pharmacists
Replies
1
Views
2K
Dred Pirate
Dred Pirate
owlegrad
CVS sucks now
Replies
6
Views
4K
clarkbar
C
D
Cvs rx connect question
Replies
1
Views
2K
Old Timer
Old Timer
P
CVS 401k Match Contribution Date
Replies
1
Views
2K
RxPreceptor
RxPreceptor
P
CVS Walkout
2
Replies
73
Views
9K
knight on horse
knight on horse
Top