http://time.com/4952176/cvs-pharmacy-opioid-epidemic/

With the 64,000 deaths from opioid overdoses last year alone, the medical community is struggling to contain the out-of-control opioid epidemic. Now, CVS, one the nation’s largest pharmacy benefit managers that oversees prescription drug benefits for 90 million people through its CVS Caremark plan, is attempting to address opioid abuse by no longer reimbursing opioid prescriptions beyond the first week for people filling these prescriptions for the first time.

Beginning in February, the company announced, it will adhere to the Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing opioids that limit doses and duration of the drugs prescribed by doctors. The CDC recommends prescribing the painkilling narcotics, which can be highly addictive, in as low a dose as possible for as short a time as needed. Not only will CVS Caremark only reimburse for seven days of prescriptions, but for first-time opioid prescription-fillers it will also dispense short-acting, rather than extended release, versions of the drugs for these patients.

The pharmacy benefit managers who authorize prescriptions for CVS Caremark plan members, as well as pharmacists at CVS retail pharmacies, will be spending more time explaining to patients and doctors why some of their opioid prescriptions won’t be filled as ordered. “We estimated how long it would take for these conversations, and we are staffing up to do that,” says

Dr. Troyen Brennan, chief medical officer of CVS.

https://www.linkedin.com/in/troyen-brennan-494bb533/

Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Caremark. In this role, Dr. Brennan provides oversight for the development of CVS Caremark’s clinical and medical affairs and health care strategy, as well as the company’s MinuteClinic and Accordant Health Care businesses.

Previously, Dr. Brennan was Chief Medical Officer of Aetna Inc., where he was responsible for clinical policies, as well as Aetna’s full range of clinical operations, disease management programs and patient management services. Prior to that, Dr. Brennan served as president and CEO of Brigham and Women’s Physicians Organization. In his academic work, he was Professor of Medicine at Harvard Medical School and Professor of Law and Public Health at Harvard School of Public Health.

Dr. Brennan received his M.D. and M.P.H. degrees from Yale Medical School and his J.D. degree from Yale Law School. He has a Master’s Degree from Oxford University, where he was a Rhodes Scholar. He earned a BS from Southern Methodist University. He completed his internship and residency in internal medicine at Massachusetts General Hospital. He is a member of the Institute of Medicine of the National Academy of Sciences.

According to this website  http://www.hipaaspace.com/Medical_Billing/Coding/NPI/Codes/NPI_1174686265.aspx   which indicates that he only licensed to practice medicine in the state of Massachusetts.

Here’s how the changes will work: If a patient has a prescription for several weeks’ worth of opioids and wants to fill the prescription for more than seven days, he will need pre-authorization for the drugs—obtained after the pharmacy benefit manager speaks to the prescribing doctor—and will have to pay for them out of pocket.

Pharmacists already call doctors when they have questions about the duration or appropriateness of medications to treat certain conditions, and Brennan says he anticipates more of those conversations will take place as doctors also make an effort to adjust their opioid prescribing practices to adhere to the CDC guidelines. “A lot of doctors are moving in the direction of the CDC guidelines and counseling patients along the same pathway,” he says. “What we see ourselves doing is reiterating that and doing our part.”

Brennan estimates that the new stricter dispensing policies will affect about 300,000 people who fill prescriptions through CVS. The company is also supporting community-based addiction programs and providing education to its clients about opioid addiction and the benefits of using the drugs in the lowest dose possible for as short a time as possible.

One of the basic functions of the practice of medicine is to create a plan of treatment for a pt that includes the starting, changing, stopping a pt’s medication(s).

It would appear from this article … Dr. Troyen Brennan, chief medical officer of CVS is the person behind the decision – authorizing – the changing of the prescription(s) written by the pt’s prescriber.

It is also ILLEGAL for a prescriber to change a pt’s plan of treatment… without doing a IN PERSON PHYSICAL EXAM…

It is also ILLEGAL for a prescriber to “practice medicine” in a state in which they are not licensed

Since the CVS Health corporation has apparently decided to “play doctor” with all those patients who either have chosen CVS Pharmacy or has the misfortune of having CVS/Caremark as the PBM that processes their prescription claims – regardless of which pharmacy they chose to patronize.

A corporation cannot be a DOCTOR… they cannot have a medical degree… they can’t take a medical licensure test… thus a corporation CANNOT PRACTICE MEDICINE… so who within CVS HEALTH would be the corporate officer that would think they would have the authority to issue such blanket medical mandates ? CHIEF MEDICAL OFFICER OF CVS ?

This statement concerns me:

Here’s how the changes will work: If a patient has a prescription for several weeks’ worth of opioids and wants to fill the prescription for more than seven days, he will need pre-authorization for the drugs—obtained after the pharmacy benefit manager speaks to the prescribing doctor—and will have to pay for them out of pocket.

The DEA has declared as a RED FLAG any pt paying CASH for a controlled substance … that has insurance. So is CVS documenting that a pt with insurance is paying cash for a controlled substance… something that they could provide to the DEA to “mark” doctors, CVS pharmacy competitors, pts that are throwing RED FLAGS ?

So what about Dr Brennan… according to his profile.. he is both a medical doctor and a licensed attorney… so he knows or should know what his limitations are under his medical license that he holds in Massachusetts and apparently ONLY MASSACHUSETTS ?  BUT CVS Health/Caremark manages prescriptions in all 50 states ?

What I suspect they will attempt to do to dodge the claim of practicing medicine without a license is to get the pt’s prescriber to AGREE  WITH THEIR POLICIES/DEMANDS and that way it will be the decision of the pt’s prescriber…  PERFECTLY LEGAL !!!

They will try and take advantage of the prescribers being “pressed for time” and just agree to get it off their plate and out of their face. There is no means of the prescriber to “fund” the time it takes to discuss/argue a prior authorization.  BUT.. the prescriber made his/her decision what was in his/her professional opinion what medication was right for this pt this time.. and for it to be changed was because they were cajoled by CVS staffing…. to make the change…

Should the pt move ahead…  get a statement from the prescriber that he/she was cajoled to change the ordered medication… then file complaints with the Massachusetts’ Medical board and the medical licensing board in the state in which the pt lives… about CVS Health & Dr. Troyen Brennan, chief medical officer of CVS violating the various laws outlined above.

If the pt is covered by Medicare/Medicaid – file complaints with www.cms.gov 800-MEDICARE

If the pt’s insurance is from an employer and the employer is self-funded (ERISA).. file complaints with the dept within the employer over denial of care.. ERISA insurance … the insurances – like CVS Health – are just shuffling the paperwork for the employer and paying the bills for their employers – WITH THE EMPLOYER’S MONEY… and they get paid an administration fee for doing so.

There may be other avenues to be utilized… all I know is that both Barb and myself have had the same part D provider since 2006 and is now owned by CVS/Health/Silver Scripts and I know that our PCP will not cave and I will pursue any/all avenues to allow us to follow our PCP’s medical orders and get Silver Scripts to pay for those same medications.

 

Filed under: General Problems