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Express Scripts program to limit first-fill opioid prescriptions moves forward

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Express Scripts Holding Co. is forging ahead with its plan to limit first-fill opioid prescriptions to seven days despite criticism from the nation’s largest doctor advocacy group.

St. Louis-based Express Scripts, the largest pharmacy benefits managers, will implement the program on Sept. 1, offering its Advanced Opioid Management program to both group health and workers compensation clients, according to a spokeswoman.

Express Scripts introduced the program in June, along with data from a pilot study of more than 100,000 Express Scripts members new to opioid therapy where researchers observed a 19% decrease in the day's supply of opioid dispensing during six months of follow up after its early intervention, according to a press statement. The company also found that only 3% of opioids were prescribed by pain specialists, according to the statement.

Meanwhile, an American Medical Association key member has been outspoken about the program.  

Dr. Patrice Harris, an Atlanta psychiatrist who chairs the American Medical Association's Opioids Task Force, released a statement saying doctors are already addressing the opioid epidemic.

“When patients seek physician help for an opioid use disorder — or need comprehensive care for chronic pain — one-size fits all limits, such as blanket prior authorization protocols, may cause delays in care that could severely harm patients,” she said in the statement. “While physicians continue to make important strides in making more judicious prescribing decisions — evidenced by the 17 percent nationwide decrease in opioid prescriptions since 2012 — it is critical that we prescribe opioids only when the benefits outweigh the risks.”

Ms. Harris said if prescription opioids are indicated, the American Medical Association recommends that physicians prescribe the lowest effective dose for the shortest possible duration for pain severe enough to require opioids.

“If opioids are not indicated, then we need payers and (pharmacy benefits managers) to work with physicians to ensure that patients have access to non-opioid and non-pharmacologic treatments,” Ms. Harris said. “This is critically important as more patients now are dying from heroin and illicit fentanyl than from overdoses due to prescription opioids.”