CVS Pharmacy to Strengthen Policies Around Dispending Opioids and Require Use of Prescription Monitoring Program in Groundbreaking Settlement
Pharmacy Chain to Pay Total of $795,000; AG’s Office to Direct $500,000 of Settlement to Address Opioid Dependence and Addiction
BOSTON – In a first-in-the-nation settlement with the largest pharmacy chain in the country, Attorney General Maura Healey announced today that CVS Pharmacy, Inc. (CVS) will strengthen its policies and procedures around the dispensing of opioids and will require its Massachusetts pharmacy staff to check the state’s Prescription Monitoring Program before filling prescriptions for commonly misused opioids.
The assurance of discontinuance, filed today in Suffolk Superior Court, along with a separate settlement agreement between CVS and AG Healey’s Office, resolves allegations that CVS failed to provide its Massachusetts pharmacists with a way to access the Massachusetts Online Prescription Monitoring Program (PMP) prior to March 2013. The PMP provides the prescription history of a patient that can help identify drug-seeking behavior.
The assurance and settlement agreement also resolve allegations that certain CVS pharmacies in Massachusetts failed to monitor drug use patterns or use sound professional judgment when dispensing controlled substances, particularly opioids.
“To effectively combat the opioid epidemic that is claiming lives and devastating families and communities across our state, we must work together to use all tools at our disposal,” said AG Healey. “Through this groundbreaking settlement, these pharmacists will be better equipped to responsibly dispense opioids and will be required to use the Prescription Monitoring Program, which is a vital resource in preventing the misuse of opioids.”
“This is an important first step in enforcing critical prevention measures needed to address the opioid crisis in our communities across the Commonwealth and our country,” said Dr. Myechia Minter-Jordan, President and CEO of The Dimock Center. “As a community healthcare provider and leader in substance abuse treatment, we are committed to providing comprehensive services that are vital to people’s success in maintaining long-term sobriety. Prevention and education are essential pieces to ending this epidemic.”
“The opioid crisis is an epidemic – one we must address through smart health interventions across prevention, intervention, treatment, and recovery,” said Dr. Monica Bharel, Commissioner of the Department of Public Health (DPH). “MassPAT, the newly redeveloped PMP online system, is one of the most essential tools prescribers and pharmacists have at their disposal.”
AG Healey’s Medicaid Fraud Division conducted an investigation into CVS after a referral from the state’s Medicaid program (MassHealth) relating to the state’s Controlled Substance Management Program (CSMP). A subsequent investigation was conducted by AG Healey’s Consumer Protection Division related to the PMP, where it was discovered that CVS failed to provide sufficient internet connectivity to access the online program.
Many of the more than 350 CVS pharmacies in Massachusetts are MassHealth providers and therefore must comply with all applicable state and federal statutes and regulations governing its participation in the program.
The PMP, a secure website maintained by DPH, collects dispensing information on certain controlled substances, including opioids, dispensed pursuant to a prescription. Through enrollment in and utilization of the PMP, doctors and pharmacists can access patient prescription history information which can be used to assist in clinical decision-making and to prevent or stop the abuse or misuse of controlled substances. The PMP is one component of a larger effort to address the opioid epidemic in Massachusetts.
As a result of today’s agreement, CVS will require its entire Massachusetts pharmacy staff to access the PMP website and review the prescription holder’s prescription history before dispensing certain prescribed drugs.
MassHealth administers the CSMP, a program for its members who use large quantities of prescribed drugs. Except in very limited circumstances, CSMP regulations restrict a CSMP member to obtaining all prescribed medications from a single pharmacy known as the member’s primary pharmacy. The primary pharmacy is required to monitor the prescription use pattern of each CSMP member and use sound professional judgment when dispensing all prescription drugs.
The AG’s investigation found that in certain instances, CVS pharmacies in Massachusetts dispensed controlled substances to MassHealth members enrolled in the CSMP in exchange for an out-of-pocket payment, which the AG’s Office alleges is a violation of state laws and regulations. The AG’s Office further alleges that some of these transactions occurred despite a prior denial by MassHealth of a claim for the same controlled substance on the same day.
Pursuant to the assurance, CVS will update its written policies and procedures and conduct annual training with respect to the responsibilities of primary pharmacies, the restriction on non-primary pharmacies to not dispense to a CSMP member, and concerns about CSMP members who attempt to pay out-of-pocket for prescriptions for controlled substances.
CVS is also required to update its written policies and procedures and conduct annual training to include the requirement that CVS’s Massachusetts pharmacy staff use the state’s Prescription Monitoring Program before dispensing certain prescribed drugs.
As a part of these settlements, CVS has also agreed to make a payment of $795,000 to the state, $500,000 of which will be used to address opioid dependence and addiction in Massachusetts.
This case is one more way AG Healey is working to address the growing addiction crisis in Massachusetts. The AG’s Office is looking at a host of other practices, from marketing by pharmaceutical companies, to pill diversion and drug trafficking by criminal entities, to coverage for substance abuse treatment by insurance companies.
Earlier this year, the AG’s Office announced the formation of the Interagency Group on Illegal Prescribing, a coalition of state and federal agencies to investigate and prosecute prescribers, pharmacists and others who contribute to the opioid epidemic by illegally prescribing or dispensing pills.
Changing the culture around the prescribing of opioids is also a significant part of the AG’s efforts. AG Healey sent a letter supporting the CDC for drafting guidelines that will provide much-needed information to primary care providers across the country about when and how opioids should be prescribed for chronic pain – creating a single, nationwide, evidence-based standard. The guidelines proposed by the CDC make clear that addictive opioids should not be the initial treatment for chronic pain and should only be used where their benefits outweigh the risks.
AG Healey also joined 35 attorneys general in sending a letter to the CDC that supports the strong framework for providers and clear guidelines that will provide a foundation for practice, recognizing that doctors will need to adapt them to meet the individual needs of their patients.
The AG’s Office continues to work on solutions that include eliminating barriers to treatment and supporting prevention and education initiatives across the state.
This case was handled by Deputy Division Chief and Chief of Investigations Kevin Ready, Assistant Attorney General Stephany Collamore, and Investigator Chris Cecchini of the AG’s Medicaid Fraud Division, Assistant Attorney General Colleen Nevin of the AG’s Consumer Protection Division, and James O’Hara of the AG’s Investigations Division.