CVS Health moves to limit access to opioid painkillers

http://www.foxbusiness.com/markets/2017/09/21/cvs-health-moves-to-limit-access-to-opioid-painkillers.html

I am not going to copy/paste this entire post… from Fox Business article… if you do web search of “CVS limits opiates” you will get DOZENS OF PAGES from various sources

“One of the largest managers of pharmaceutical benefits in the U.S. says it will start limiting the duration and dose of some prescriptions for opioid painkillers, in an effort to combat widespread addiction.”

There is little hard evidence that the legal prescribing of opiates to pts with a valid medical necessity causes addictions, but is the FOR PROFIT CVS Health taking advantage of the fabricated opiate crisis to help pad their bottom line at the expense of the quality of life of a lot of opiate dependent chronic pain pts ?

IMO, there is a lot of “practicing medicine without a license” going on.

CVS would limit opioid prescriptions to seven days or less for certain patients with acute pain who haven’t previously taken an opioid painkiller.

CVS will also limit patients with chronic pain to a maximum daily dose of 90 morphine milligram equivalents, or MMEs, a standard unit of measure in pain medicine, Dr. Brennan said.

Starting in February 2018, if CVS-covered patients arrive at the pharmacy with a prescription above the new limits, the pharmacy will kick it back to the doctor for review, Dr. Brennan said.

So CVS is providing a “second opinion” to all prescribers .. whether they ask for it or not ?… except …. There will be ways around the rules — doctors will be able to appeal the limits, 

But the “way around the rules” .. is normally referred to as a PRIOR AUTHORIZATION… which involves TIME… and as we all know TIME IS MONEY…  and CVS and others involved in paying for prescriptions … knows that prescribers are already pushed for time and often it is easier for the prescriber to AGREE than fight the denial.  In other words… is it easier for CVS to increase profits than for the prescriber to make sure that their pts get their necessary medication(s).

Since many prescribers have a time management incentive to JUST AGREE.. it will fall back on to the pt to “take the bull by the horns”  If you are on Medicare/Medicare Advantage” here is the 2018 Medicare and You 2018 booklet

https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf   page 103 – Section 9 Know your Rights and Protect Yourself from Fraud.  This provides the pt’s rights under Medicare and how to appeal.

I would suggest that all pts make a photo copy of their prescription before handing it over to a Pharmacist. I also suggest that all pts audio/video record all interactions with Rx dept staff.  Pharmacists like all other healthcare professionals are pressed for time and contacting a prescriber to get the authorization to dispensed a reduced amount… may be used to get the pt to agree to the reduced amount of opiates are wait a unknown period of time for the prescriber to return the Pharmacist’s call.

Legally a Pharmacy can provide a partial amount and furnish the balance of a C-II within 72 hrs.  Don’t agree to a reduced amount of doses… agree to a partial fill with the understanding that the Pharmacists will contact the prescriber and if the prescriber refuses the reduced amount… the Pharmacist can’t state that the pt agreed to a reduced amount – because the pt has been doing a audio/video recording to prove what was said and what was done or what was not said and not done.

The FEDS have increased that 72 hr period to 30 days, but not all states have changed their state laws to align with the Federal law, so the state law’s 72 hr period still prevails

What the pt should be trying to document is that their prescriptions was dispensed with fewer doses than was prescribed and the prescriber did not authorize the reduction… Meaning that someone authorized the reduction without legal authority.

It is illegal for a licensed prescriber to prescribe (start, change, stop medication) without first doing a in person physical exam and it is also illegal for a prescriber to “practice medicine” in a state in which they are not licensed.

If the pt can document that they were provider fewer doses than their prescriber authorized, it will be up to the pt to start filing complaints and grievance with various federal/state agencies.

If the pt believes that the pharmacist or some person working for CVS, another PBM or insurance company has caused the number of doses to be reduced and it was not authorized by the pt’s prescriber…  here are web sites to go to …to file complaints about practicing medicine without a license

Defintion: 

prescriptive authority

(prē-skrĭp-tĭv)

http://physicianjobs.us/Medical%20Boards.htm

https://nabp.pharmacy/boards-of-pharmacy/

If the pt believes that they have been discriminated against and/or denied proper therapy:

https://www.ada.gov/filing_complaint.htm

https://www.justice.gov/crt/how-file-complaint

https://www.medicare.gov/claims-and-appeals/file-a-complaint/complaint.html   800-Medicare

without proper documentation – copy of the prescriptions, audio/video recording of what was said and prescriber verifying that they did not authorize a change in the quantity and the pt did not agree to a change (partial fill) of the prescription(s) – it will be the pt’s word against everyone else… and the pt will most likely be labeled as a lair and drug seeker or addict.

If only a few pts follow thru and file complaints/grievances… those agencies will just label those filing complaints as unhappy substance abusers/addicts and their complaints will be dismissed or discarded.

 

 

 

 

 

 

 

 

 

 

Filed under: General Problems