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The nation's largest pharmacy benefit manager will soon limit the number and strength of opioid drugs prescribed to first-time users as part of a wide-ranging effort to curb an epidemic affecting millions of Americans.
But the new program from Express Scripts is drawing criticism from the American Medical Association, the largest association of physicians and medical students in the U.S., which says treatment plans should be left to doctors and their patients.
About 12.5 million Americans misused prescription opioids in 2015, according to the U.S. Department of Health and Human Services. More than 33,000 deaths that year were blamed on opioid overdoses.
Express Scripts launched a yearlong pilot program in 2016 aimed at reducing patients' dependency on opioids and the risk of addiction, said Snezana Mahon, the Missouri-based company's vice president of clinical product development. Mahon said analysis of 106,000 patients in the pilot program showed a 38 percent reduction in hospitalizations and a 40 percent reduction in emergency room visits, compared to a control group.
Under the program, new opioid users are limited to seven-day prescriptions, even if the doctor orders scripts for much longer. Mahon said the average prescription is for 22 days. The program also requires short-acting drugs for first-time opioid prescriptions, even though many doctors prescribe long-acting opioids.
Dosage is also limited, and the company will monitor and try to prevent for patterns of potential "pill shopping," where a patient goes from doctor to doctor to collect prescriptions.