Express Scripts expands program to limit opioid prescriptions

One in five users who start on a 10-day supply of opioid medication become long-term users.
One in five users who start on a 10-day supply of opioid medication become long-term users. | File photo

Express Scripts, one of the largest pharmacy benefit managers (PBMs) in the country, has announced the expansion of a pilot program that limits opioid prescriptions to seven days without prior authorization.

Currently, the average prescription is for 22 days, according to the company, which argued that its move was its response to the opioid crisis bedeviling many parts of the country.

"Opioid misuse is a serious problem that is not getting better, and we need to take bold actions to do all we can to stop abuse before it begins, and make the use of these medications safer for our members," Jennifer Luddy, communications director for Express Scripts, told American Pharmacy News.

As part of the program that begins Sept. 1, doctors are required to first prescribe short-acting drugs, which are believed to lessen the risk of a patient becoming addicted. Dosage is also limited. The program does not apply to patients in hospice, palliative care, or those suffering from cancer.

The program has drawn criticism from the American Medical Association (AMA).

Dr. Patrice Harris, an Atlanta psychiatrist who chairs the AMA's Opioids Task Force, said doctors have reduced prescriptions by 17 percent in recent years, but are also in the best position to know when a patient can be directed toward alternative therapies.

"We want to be proactive in making sure the alternatives are available, vs. a sort of blunt, one-size-fits-all approach regarding the number of prescriptions," Harris told ABC News. "The AMA's take has always been that the decision about a specific treatment alternative is best left to the physician and their patient."

Luddy said overprescribing opioids is a leading cause of misuse.

"One in five users who start on a 10-day supply of opioid medication become long-term users," she said. "Seventy percent of abused prescription medications are obtained from family and friends, many of whom have unused, and unnecessary, medication on hand."

Luddy added, "Our program seeks to address that while also making sure those who rely on these medications have access to them without delay. For new patients, we are trying to prevent situations where a patient with acute pain who has never used an opioid gets more opioid medication than they really need; for example, a patient getting a 22-day prescription for a tooth extraction. "

Luddy further argued that Express Scripts "has worked diligently and invested millions to improve the prior authorization process and experience for the physician and the patient."

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