CVS Caremark Targets Inappropriate Prescribers to Cut Prescription Drug Abuse

The chain’s pharmacies stopped filling prescriptions for controlled substances written by 36 physicians it had identified as inappropriate prescribers.

As the number of deaths caused by prescription drug overdose continues to rise in the United States, especially those caused by opioid analgesics, CVS Caremark pharmacies have initiated a new program to help combat drug abuse.

The program, detailed in an article published online on August 21, 2013, in the New England Journal of Medicine, uses the company’s large database as a means of identifying physicians who are inappropriately prescribing high-risk drugs and those who are potentially involved in pill mills and then stops filling controlled-substance prescriptions written by these physicians.

Using information on prescriptions filled throughout CVS Caremark pharmacies between March 2010 and January 2012 for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol, investigators compared the prescribing patterns of physicians against others within the same geographic area and specialty. Prescribers were compared based on the volume of prescriptions and the portion of overall prescriptions they wrote for the specified drugs. Physicians in the 98th percentile for volume and 95th percentile for portion were considered to be outliers and potentially involved in suspicious activity.

To more accurately identify pill mills, which often run on cash and cater to younger patients, the amount of patients who paid cash and the portion of patients aged 18 to 35 receiving the specified drugs were also analyzed for each prescriber and compared with overall norms.

Of nearly 1 million prescribers in the database, 42 were identified as outliers and were asked to participate in interviews to determine whether they were appropriately prescribing controlled drugs. Seventeen failed to respond, 7 sent inadequate written responses (compared with 1 written response that was deemed adequate), and 2 communicated through an attorney. These 26 prescribers were considered nonresponsive, and CVS Caremark pharmacies stopped filling their prescriptions for controlled substances. Of the 15 prescribers who participated in phone interviews, 5 provided legitimate reasons for their prescribing patterns. The other 10 could not provide adequate reasons, and the chain’s pharmacies stopped filling their prescriptions for controlled substances as well. In the 9 months after their controlled-substance prescriptions stopped being filled, only 3 of the 36 suspended prescribers requested that the chain resume filling their prescriptions.

Although the authors of the article acknowledge that the program will not solve the prescription drug abuse epidemic, they write that it offers valuable insight into inappropriate prescribing patterns. In addition, they call on policymakers to initiate large-scale programs to combat prescription abuse at the pharmacy level.

“A comprehensive solution would involve the use of a national prescription-drug—monitoring database that would be used by clinicians at the point of prescribing and by all pharmacies at the point of dispensing,” they write. “This enhanced view of a patient’s controlled-substance history and behaviors would support both prescribers and pharmacists in applying their professional judgment regarding the appropriateness of dispensing a controlled substance.”