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An order from the judge overseeing the National Prescription Opiate Litigation should make it easier for healthcare providers to comply with best practices designed to reduce opioid abuse.
U.S. District Judge Dan Polster entered an order confirming that the three largest pharmacy benefit managers (PBMs) in the country either have or will implement changes designed to curb the overuse of opioids. They will comply with the CDC’s Guidelines for Prescribing Opioids for Chronic Pain.
The order was in response to a motion from Webb County, TX, filed in September 2018, addressing the fact that PBM standard national offerings were not consistent with the CDC Guidelines, even though PBMs had endorsed the guidelines as the standards of care. (The court order is available online at: https://bit.ly/33jSCW8.)
Webb County co-counsel Kevin Sharp, JD, managing partner of Sanford Heisler Sharp in Nashville, TN, and a former judge on the U.S. District Court for the Middle District of Tennessee, says, “The catalyst for filing this motion was that the CDC had come out with these guidelines years ago and the PBMs weren’t following them, even though they are in a very good position to influence opioid use and curb misuse. Judge Polster’s goal is to solve this problem to the extent that the judicial process can solve it, and recognized that PBMs are part of the triumvirate controlling opioids.”
The order outlined steps taken by the PBMs Caremark, Express Scripts, and OptumRx to promote restrictions on the strength and supply of opioid drugs prescribed to patients, the availability of medication-assisted treatment, and heightened restrictions on opioid prescriptions for minors.
Prior to PBM compliance with the guidelines, physicians sometimes found it difficult to prescribe alternatives to opioids or take other measures to reduce abuse because the PBM practices got in the way, Sharp says.
Providers have been encouraged to think before prescribing opioids, as the CDC guidelines do not mandate anything and leave individual healthcare decisions to the physician.
“This order reaffirms the CDC guidelines. PBMs had such ability to control the thought process of providers with how things get paid, if things are on a formulary, where they are on the tiers in a formulary,” Sharp says. “By having them acknowledge the CDC guidelines, it gives providers more options about prescription options that will be paid for and lets them comply with the best practices without PBMs getting in the way. There should be relief that there are options now that they can get paid for.”
Financial Disclosure: Author Greg Freeman, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Accreditations Manager Amy Johnson, MSN, RN, CPN, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Arnold Mackles, MD, MBA, LHRM, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.