The American Medical Association, the nation’s largest doctors group, is criticizing pharmacy benefits manager Express Scripts for its plans to limit the number and strength of painkillers that it will allow doctors to prescribe to first-time patients.
The move from Express Scripts is part of a larger effort to stave off the opioid epidemic, which resulted in 33,000 overdose-related deaths in 2015, according to the latest available data from the Centers for Disease Control and Prevention. Most of the patients who become addicted to opioids received a painkiller prescription from a doctor. Data indicates that people have transitioned to the drug’s cheaper, more available alternative, heroin, which is driving the latest increases in opioid-related deaths.
The American Medical Association criticized the move Wednesday, saying that those decisions should be left to doctors and their patients.
The program creates exemptions for patients with cancer or who are receiving palliative or hospice care.
Under the new plan, first-time opioid users will not be able to receive more than seven days of prescription painkillers, even if the doctor requests a longer prescription. Snezana Mahon, Express Script’s vice president of clinical product development, told the Associated Press that a study the company conducted showed opioid prescriptions are written for an average of 22 days.
Most doctors also prescribe long-acting opioids, but the new plan will limit prescriptions to short-acting drugs and limit the dosage. Express Scripts plans to monitor prescribing data to see if patients are “pill shopping,” meaning going to different doctors’ offices to stock up on the same medication.
The program is similar to one by its competitor CVS Caremark, which limits opioids to a 10-day supply and restricts the dosage.
Jennifer Luddy, spokeswoman for Express Scripts, said the company did a pilot test of its program and observed a 38 percent reduction in hospitalizations and a 40 percent reduction in emergency room visits after educating patients about the risk of opioid use. The company also sent an educational letter to providers who showed high prescribing patterns and held counseling calls, finding a 19 percent drop in prescribing six months later. “Patients got the medicine they need while we helped prevent unnecessary refills that could put patients at risk of significant harm,” she said.
Dr. Patrice Harris, a chairwoman for the American Medical Association’s Opioids Task Force, told the AP that doctors already are working on addressing the opioid epidemic, reducing prescriptions by 17 percent in recent years, and are referring patients with chronic pain to physical therapists and cognitive behavioral therapy.
