CVS Caremark Corp. is barring controlled substance prescriptions from three dozen health care providers after an analysis identified them as prescribing unusually high numbers of high-risk drugs such as opioid painkillers.

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CVS Caremark cuts off questionable prescribers of controlled substances

August 22nd, 2013

WOONSOCKET, R.I. – CVS Caremark Corp. is barring controlled substance prescriptions from three dozen health care providers after an analysis identified them as prescribing unusually high numbers of high-risk drugs such as opioid painkillers.

The company said Thursday that it evaluated data on prescriptions filled at CVS/pharmacy to flag health providers with "extreme patterns" of prescribing such drugs and suspended controlled substance dispensing for those who couldn't justify their prescribing habits.

CVS Caremark identified problem prescribers by studying their volume and share of high-risk drugs versus other providers in the same specialty and geographic region, as well as the ages of patients and their payment methods. Forty-two prescribers were then asked to provide more information about their prescribing habits and, of those, only six identified legitimate reasons for their unusual prescribing practices.

As a result, CVS Caremark said it has suspended controlled substance dispensing through CVS/pharmacy locations and the CVS Caremark Mail Service pharmacies for prescriptions written by those 36 providers.

Details of the program were published online in an article for The New England Journal of Medicine (NEJM) that was co-authored by Troy Brennan, executive vice president and chief medical officer for CVS Caremark, and Mitch Betses, senior vice president of pharmacy services for CVS/pharmacy.

"While this program is not a comprehensive solution to prescription drug abuse, it is an important first step that is in line with the ethical duty pharmacists have to ensure that a prescription for a controlled substance is appropriate," Betses said in a statement. "We know there are many ways to fight prescription drug abuse, and we are committed to continuing to identify solutions to stop the improper use of controlled substances."

In the NEJM article, titled "Abusive Prescribing of Controlled Substances: A Pharmacy View," Brennan and Betses noted that the use of controlled substances has surged, with prescriptions for opioids rising more than 300% from 1999 to 2010. And during that time span, deaths from overdoses climbed from 4,000 annually to 16,600. Such overdoses are now the nation's second-leading cause of accidental death, and in 2010 more than 2.4 million people were considered to be opioid abusers.

"Prescription drug abuse in this country is an epidemic, but it doesn't have to be," Brennan stated. "CVS Caremark, one of the largest providers of prescription drugs, is committed to mitigating prescription drug abuse by advancing legislation, promoting technology and creating safer communities."

The article highlights the role pharmacies can play in helping to curb the prescription drug abuse. Brennan and Betses also call on state and federal lawmakers and regulators to enact policy changes that fos more transparency into controlled substance prescribing, such as mandatory use of electronic prescribing, and a national, uniform program for prescription drug monitoring.

CVS Caremark added that it's working at the federal and state levels to promote mandatory e-prescribing for controlled substances, improve state prescription drug monitoring programs (PDMPs), and encourage proper disposal of prescription medications. 

With rising abuse of controlled substances, notably opioid pain relievers such as oxycodone, the Drug Enforcement Administration (DEA) has stepped up efforts to police prescribing and dispensing.

For example, in June, Walgreen Co. agreed to pay $80 million in civil penalties under a settlement with the DEA and the Department of Justice regarding the distribution and dispensing of controlled substances in Florida. The DEA said the settlement, the largest in its history, resolved charges that Walgreens' Jupiter distribution center and six Walgreens drug stores in Florida committed record-keeping and dispensing violations by negligently allowing drugs such as oxycodone and other prescription painkillers to be diverted for abuse and illegal black market sales.

Last September, the Drug Enforcement Administration revoked the controlled substance licenses of two CVS/pharmacy stores in Sanford, Fla. The agency charged that the pharmacies improperly filled prescriptions for painkillers, particularly oxycodone, and had suspicious sales of other controlled substances.

And in May 2012, Cardinal Health Inc. agreed to a two-year suspension of its Lakeland, Fla., distribution center's registration to ship controlled substances. That February the DEA had issued immediate suspension orders (ISOs) to Cardinal's Lakeland facility and four of its pharmacy customers, including two CVS drug stores in Sanford, Fla. The agency claimed that the distribution center failed to control the diversion of controlled substances into other than legitimate channels and didn't perform due diligence to ensure that those drugs weren't diverted.