CVS Caremark Corp said on Wednesday that it has taken the unusual step of cutting off access to powerful pain-killers for more than 36 doctors and other healthcare providers found to prescribe the drugs at an alarmingly high rate. The drugstore chain, which was drawn into a government crackdown on prescription painkiller abuse last year, began revoking the dispensing privileges of certain providers in late 2012, said CVS Chief Medical Officer Troyen Brennan. “This isn’t a definitive solution to the problem,” Brennan told Reuters. “We wanted to share what it was that we did and have other people in healthcare, including other pharmacies, look at what we did and discuss what some more comprehensive solutions might be.”
CVS disclosed the suspensions in an article published on Wednesday on the website of the New England Journal of Medicine. “At CVS, we recently instituted a program of analysis and actions to limit inappropriate prescribing. Our program was intended to identify and take action against physicians and other prescribers who exhibited extreme patterns of use of ‘high-risk drugs’ relative to other prescribers.”
CVS identified high-risk prescribers by benchmarking them against others on several parameters. It used data from submitted prescriptions from March 2010 through January 2012 for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol. Prescribers were compared with others in the same geographic region who had the same listed specialty. The first parameters were the volume of prescriptions for high-risk drugs and the proportion of the prescriber’s prescriptions that were for such drugs, as compared with the volume and proportion for others in the same specialty and region; the thresholds for suspicion were set at the 98th percentile for volume and the 95th percentile for proportion.
Next, prescribers were evaluated with regard to the number of their patients who paid cash for high-risk-drug prescriptions and the percentage of their patients receiving high-risk drugs who were 18 to 35 years of age. In both cases, the thresholds for suspicion were set at the 90th percentile among clinicians in the same region and specialty.
Finally, CVS compared the prescriptions for noncontrolled substances with the prescriptions for controlled substances within the prescriber’s practice on the same parameters. CVS initially identified 42 outliers from the database of nearly 1 million prescribers. To minimize the possibility that CVS would suspend dispensing privileges for clinicians who were appropriately treating patients, it attempted to interview physicians who were identified as outliers to ascertain the nature of their practice and their use of controlled substances. After further screening, 36 met the criteria for suspension.
Pharmacists have an ethical duty, backed by both federal and state law, to ensure that a prescription for a controlled substance is appropriate. The DEA has now identified both pharmaceutical distributors and chain pharmacies as part of the problem, encouraging the industry to develop new programs to reduce inappropriate use.