It’s getting harder and harder to fill an opioid prescription. Many pharmacies – particularly chains – are very reluctant to dispense them in the first place. Many require a patient to go through various procedural issues such as signing a lock-in contract. While others are capping the amount of opioids to be dispensed. The latter is becoming more and more popular.
For example, this month Walmart joined the move and announced that it will start capping the initial dispensing of opioids to a seven-day supply. Walmart’s announcement. In addition, Walmart is capping the dosage to a maximum of 50 morphine milligram equivalents per day.
Walmart has been really proactive in curbing opioid epidemic (and minimizing its legal exposure) this year. It started offering free counseling to its patients on proper opioid use, possible overdose, and addiction. Earlier this year, Walmart also started offering a first-of-its kind free opioid disposal solution, DisposeRx.
DisposeRx contains powder which is to be emptied in a pill bottle containing opioids with warm water. According to manufacturers of DisposeRx, their product effectively and responsibly disposes of opioids.
By 2020, Walmart plans to switch to e-prescribing, which will enable its pharmacists to receive controlled substance prescriptions electronically, reducing the error rate and tampering issues.
Walmart is not the first in the industry to implement such comprehensive measures on preventing over-dispensing and potential overdose/addiction of opioids. For instance, CVS started the move last year after the Centers for Disease Control and Prevention (CDCP) issued its recommendations on capping initial opioid dispensing to seven-days only. CDCP’s guidelines. Some states also limit opioid prescriptions to seven days or fewer.
In February 2018, Caremark announced a seven-day cap as well. Pharmacies – within the Caremark network – which are not adhering to this policy would not be reimbursed beyond the seven-day dispensing and could potentially face contractual issues.
The industry is reshaping how the opioids are dispensed. It is important for pharmacies to watch the move and ever-changing standard of care. These changes are attributed not to altruistic motives but to the level of enforcement against pharmacies, wholesalers, pharmaceutical companies, and prescribers. In California, for example, dispensing controls is still a number one violation cited in the California State Board of Pharmacy disciplinary actions. The Board does not issue citations or fines associated with the dispensing of controls but goes straight to filing the Accusations (which are publicly available). The California State Board of Pharmacy regularly seeks to revoke pharmacist licenses and pharmacy permits based on common record-keeping errors when dispensing controls (and not just on diversion or ignored red flags). In addition, DEA has been proactive in enforcing federal controlled substances laws on the pharmacy level, collecting many millions in settlements and leaving many pharmacies without DEA registration.