The Problem With How CVS and Cigna Have Responded to the Opioid Crisis

With all of the media coverage regarding the enormity of the opioid crisis, it should come as no surprise to anyone that the reaction to this incredibly dangerous and deadly addiction is to significantly limit the access to these medications. On the surface, this sounds logical, but dig just slightly deeper and realize that there are many people taking medications for chronic pain, be it from chronic disease or as a result of chronic injuries, and this blanket reform will greatly affect their access, too.

CVS decided they will help in the reduction of the over-prescription of opioids by capping the number of pills they will allow a patient to receive to a treatment length of seven days, requiring patients facing acute ailments to secure new scripts for every subsequent seven-day time period, or less, for which they need pain relief. They will also provide counseling to patients picking up medications to educate them regarding the importance of taking the most minimum dose necessary to reduce the dangers of overuse. CVS has now taken it upon itself to determine the patients’ level of need and the length of that need (with the exception of persons going through cancer treatment and those with a terminal illness).

In a slightly more recent decision, the Cigna Insurance Company will, beginning in 2018, no longer be providing coverage/payment for scripts for OxyContin/Percocet/etc., no matter what the reason or duration of its use. Their plan is to reduce opioid use by 25 percent (back to the use percentage in 2006) and to utilize a less addicting, long-acting pain medication that they deem “equivalent with abuse-deterrent properties.”

According to Goldschmidt and Kounang in their article for CNN from June, “Opioid prescriptions dropped but remain high, CDC says,” “Long-acting or extended-release medications like OxyContin contain a higher dosage of the active ingredients in the pill itself, which is chemically released over a long period of time. The advantage for patients is that they don’t have to take pills as frequently. However, the higher dosage of long-acting pills can make them more attractive for abuse. Crushing or melting some versions of extended-release pills, a user can get a day’s dosage in just one pill.”

I don’t want to sound as though I am in disagreement of the need for greater oversight and support for those struggling with addiction; I am not. But I can’t help but feel that these companies have not readily taken into account the effects of their decisions on many of the people who rely on pain medications to continue to live and function every day of their lives. Not all of these people are addicted. Not everyone who takes pain medication is abusing the medication. So, people who have moderate to severe chronic pain and related medical needs have to be subjected to greater limitations and scrutiny because of this epidemic.

Honestly, no one I know who is abusing pain meds is getting their scripts from their insurance company and filling them at CVS! They might be stealing them from someone’s medicine cabinet or buying them online (anything you want is available on the internet), so patients who see their doctors monthly and get scripts for their meds, and who have tests and diagnoses to back up the need for these medications, are being lumped into the same heap as the people who are securing their medication in less than legal and/or ethical ways.

I understand the goal is to educate doctors in the more logical scripting of medications, but how does punishing the patients who need these meds the most to live and function educating the doctors to prescribe less and use it in a more carefully chosen manner? Also, this “extended-release pill” isn’t useful for everyone. Extended-release pills are designed to break down slowly in the person’s system and finish by being absorbed in the colon. Person’s with ileostomies, who have shortened intestinal tracks, don’t have a colon and are generally missing many feet of their small intestine, too, and aren’t able to take extended-release pills because they don’t absorb the pill and it is extremely common for the pill to exit the body totally undigested! So, how will these patients be treated? Will people with absorption and digestive issues be ignored because it will help to lower the insurance companies’/drug stores’ involvement in the crisis and help make them look better to the public?

The industry is trying to control the people they can, the people who get their medications from drug store pharmacies and utilize their insurance to pay for the scripts, the people they can see, access and limit, and not working to really get to the bottom of the addiction problem, the access to illegally accessed drugs! Since it is known that overdoses of heroin and fentanyl are occurring at much greater rates, and if you consider the CNN article which states that these new, higher dose, extended-release pills “make them more attractive for abuse,” you have to wonder why anyone believes this is the answer to the opioid crisis?

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Thinkstock photo via VladimirSorokin.

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