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August 21, 2017

Express Scripts will expand a program limiting opioids—but AMA is pushing back

Daily Briefing

Express Scripts on Sept. 1 will expand a pilot program aimed at curbing the opioid misuse epidemic nationwide, but the move has drawn criticism from the American Medical Association (AMA).  

August 30 webconference: Streamline PA processes for provider-administered drugs

Program details

Express Scripts first launched the pilot program in 2016. Under the program, new opioid users are limited to a seven-day supply of the drugs, even if their health care providers have prescribed a longer regimen. The program also limits the type of drugs prescribed, requiring short-acting medications even if the provider has prescribed longer-acting opioids and restricting the overall dosage.  According to Express Scripts, physicians who wish to prescribe longer-term regimens may make a request to the company.

Further, Express Scripts issues a letter to patients who are newly prescribed opioids, cautioning them about the potential for substance misuse. Express Scripts also monitors opioid prescriptions to identify and prevent "pill shopping," where a patient who is misusing substances visits multiple providers to collect prescriptions.

The program does not apply to cancer patients or patients who are receiving hospice or palliative care, the Associated Press reports.  

According to Snezana Mahon, vice president of clinical product development for Express Scripts, an analysis of 106,000 patients enrolled in the pilot found a 38 percent reduction in hospitalizations and a 40 percent reduction in visits to the emergency department when compared with a control group.

Express Scripts intends to expand the program nationally on Sept. 1, for all members whose employers or health insurers have enrolled as a participant. According to AP, CVS Caremark operates a similar initiative, limiting opioids to certain dosages and a 10-day regimen, among other preventive measures. 

AMA's concerns

According to Mahon, some physicians are responding well to the program. She said some "are actually appreciative and saying, 'Thank you, I didn't know this was happening.'"

However, Patrice Harris, a psychiatrist and chair of AMA's Opioids Task Force, critiqued the program. She said physicians are already working on addressing opioid misuse.  For instance, Harris said some providers have curbed opioid prescriptions by 17 percent in recent years and have been redirecting patients to alternative forms of pain management, such as physical or cognitive behavioral therapy.  Harris added, "We want to be pro-active in making sure the alternatives are available, versus a sort of blunt, one-size-fits-all-all approach regarding the number of prescriptions." She continued, "The AMA's take has always been that the decision about a specific treatment alternative is best left to the physician and their patient."

Further, Harris expressed concerns about Express Scripts' proposal that physicians request longer prescriptions when needed, saying the requirement poses an administrative burden and could potentially "delay care for the patient." Harris noted that AMA has not formally raised its concerns with Express Scripts, nor made moves to try to stop the program's expansion (Salter, AP/ABC News, 8/16).

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