Express Scripts Places Limits On New Opioid Prescriptions

By Kelly Burch 08/18/17

Some physicians are concerned about the company's new "one-size-fits-all approach" to opioid prescribing limits. 

Pharmacist writing prescriptions for medicines in pharmacy

Express Scripts, the country’s largest pharmacy benefit manager, has announced that it will integrate new policies that are designed to reduce the risks of misusing or abusing opioids. 

The company will now limit new opioid prescriptions to seven days, even if a doctor writes the prescription for longer. Dosages are also limited, and the company will require short-acting opioids for first-time prescriptions rather than more powerful long-acting opioids, according to ABC News. Express Scripts will also be monitoring prescriptions to detect cases of doctor shopping

"A lot of times physicians are prescribing these drugs blindly," Snezana Mahon, Express Scripts’ vice president of clinical product development, told ABC News. "They don't know that a patient may be going to see multiple prescribers.”

The changes, which will take effect on September 1, come after a 2016 trial by the company showed that policies like these could reduce the harm from opioids. 

In 2016 the company studied over 100,000 people who were using opioids for the first time. They found that the opioid control measures resulted in a 38% reduction in hospitalizations and a 40% reduction in emergency room visits compared to a control group that did not have the restrictions. 

"By focusing across the entire care continuum—from over-prescribing to over-dispensing, and unsafe overutilization of pain medications—we found we can make a significant and meaningful difference in this national epidemic," Glen Stettin, senior vice president of clinical, research and new solutions at Express Scripts, said in a press release

"Express Scripts is uniquely positioned to engage prescribers, mobilize payers, and protect patients to comprehensively address the issue. Through our data analytics, specialized care model, fraud, waste and abuse management capabilities and our application of behavioral science, we will do more to help stop abuse before it starts,” he said. 

However, some physicians are concerned about the policy. Dr. Patrice Harris, chair of the the American Medical Association's Opioids Task Force, said that doctors are already moving away from a heavy reliance on opioids. 

"We want to be proactive in making sure the alternatives are available, versus a sort of blunt, one-size-fits-all approach regarding the number of prescriptions," said Harris. "The AMA's take has always been that the decision about a specific treatment alternative is best left to the physician and their patient."

Express Scripts’ policies will not affect cancer patients, or those receiving hospice or palliative care. The company’s main competitor, CVS Caremark, has a similar program, ABC News reported. 

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.