September 18, 2013
Novel Program Cuts Off Inappropriate Prescribers at Pharmacy Chain

Woonsocket, RI—A recent article disseminated by a major medical journal describes how CVS Caremark utilized its large pharmacy database to identify and curtail inappropriate prescribing of opioid painkillers and other high-risk drugs.

Details of the new effort, which evaluated data on prescriptions filled at CVS pharmacies and suspended controlled-substance dispensing for prescribers without adequate justification for their actions, were published online recently by the New England Journal of Medicine.

“Prescription drug abuse in this country is an epidemic, but it doesn't have to be,” said article co-author Troyen A. Brennan, MD, MPH, executive vice president and chief medical officer of CVS Caremark.

For the program detailed in the article, CVS identified problem prescribers—such as those working for “pill mills”—by studying their volume and share of high-risk drugs versus other providers in the same specialty and geographic region, as well as the ages of patients and their payment methods.

Data was used from submitted prescriptions from March 2010 through January 2012 for hydrocodone, oxycodone, alprazolam, methadone, and carisoprodol. The following steps were followed:

• First, the volume of prescriptions for high-risk drugs and the proportion of the prescriber’s prescriptions for such drugs were compared with the volume and proportion for others in the same specialty and region. The thresholds for suspicion were set at the 98th percentile for volume and the 95th percentile for proportion.
• Prescribers then were evaluated with regard to the number of their patients who paid cash for high-risk drug prescriptions and the percentage of their patients receiving high-risk drugs who were 18 to 35 years of age. For those indicators, the thresholds for suspicion were set at the 90th percentile among clinicians in the same region and specialty.
• Finally, prescriptions for noncontrolled substances were compared with the prescriptions for controlled substances within the prescriber's practice on the same parameters.

To minimize the possibility that CVS would suspend dispensing privileges for clinicians who were appropriately treating patients, an attempt was made to interview physicians identified as outliers to ascertain the nature of their practice and their use of controlled substances. Asked to provide additional information about their prescribing habits were 42 prescribers, with just six able to provide legitimate reasons for their outlying practices.

Controlled-substance dispensing was suspended at all of the company’s pharmacy locations and through CVS Caremark Mail Service pharmacies for prescriptions written by the other 36 providers.

“While this program is not a comprehensive solution to prescription drug abuse, it is an important first step that is in line with the ethical duty pharmacists have to ensure that a prescription for a controlled substance is appropriate,” said coauthor Mitch Betses, RPh, senior vice president, pharmacy services of CVS/pharmacy.

U.S. Pharmacist Social Connect