Healey cuts deal with CVS on opioids

STATE HOUSE NEWS SERVICE

CVS PHARMACY will require its staff to check the state’s prescription monitoring program database before filling certain abuse-associated opioid prescriptions under a newly announced settlement with Attorney General Maura Healey’s office.

The settlement includes a payment of $795,000 from the chain. According to the attorney general’s office, it resolves allegations that CVS failed to provide its pharmacists access to the online prescription monitoring program, in violation of consumer protection laws, before March 2013.

While law enforcement aims to cut off supplies of heroin and fentanyl, state policymakers have focused much of their addiction-prevention efforts on the legal dispensing of powerful painkillers by pharmacists at the direction of doctors.

“Pharmacists are already on the front lines,” Healey said at an event at the Dimock Center on Thursday. She said the requirement that CVS pharmacists check the prescription monitoring program is “empowering” and would likely be welcomed by pharmacists. She said, “This was never required before, and I think it is a big deal.”

An aide to Healey said the settlement marks the first time CVS has instituted a specific requirement to check the prescription database. Healey said CVS is the largest pharmacy chain in Massachusetts and the agreement will cover its 350 Bay State stores and more than 1,200 pharmacists.

Addiction to heroin and prescription painkillers has taken a major toll, with addiction visible throughout the state and a rate of four deaths per day in 2015.

The drugstore chain, which is based in Woonsocket, R.I., allegedly allowed people to bypass MassHealth restrictions on their prescriptions and did not have sufficient internet connections at some stores until March 2013, leaving them unable to access the online prescription monitoring program (PMP), according to Healey.

“CVS Pharmacy follows each state’s regulations regarding their respective PMPs,” CVS spokesman Mike DeAngelis said in an email. “Generally speaking, it is our expectation that our pharmacists use their professional judgment to determine when to check the PMP as part of their corresponding responsibility to help ensure that prescriptions for controlled substances are written for legitimate medical purposes before dispensing them.”

Asked about practices at non-CVS pharmacies, the attorney general said her office is “going to continue to work with other pharmacies on these issues,” and said the agreement with CVS would “save lives.”

The settlement was signed Tuesday by CVS Health deputy general counsel Elizabeth Ferguson and Kevin Ready, Healey’s acting chief of the Medicaid Fraud Division.

An accompanying Assurance of Discontinuance requires CVS to amend its policies by the end of the month, updating the chain’s handling of MassHealth’s controlled substance program, and mandating a check of the PMP for “certain prescribed drugs as agreed to by” the attorney general’s office and the pharmacy. “These are the ones we see diverted and sold on the streets,” Healey said.

Healey said some people receiving health insurance through MassHealth, the state’s Medicaid program, can be flagged with “don’t fill” notices that would pop up when a person attempted to fill certain prescriptions at a pharmacy. The restrictions are part of the state’s Controlled Substance Management Program, which generally requires people in the program to only go to one pharmacy, according to the attorney general’s office. The office said that out of 300 total participants statewide about 75 had CVS locations as their primary pharmacy.

In some cases at CVS, patients blocked by MassHealth from accessing certain medications were able to purchase the prescribed drugs with cash, Healey said. The agreement says the attorney general contends others purchased drugs out of pocket without first being denied coverage by MassHealth.

“This is a problem,” said Healey, who called pharmacists the “gatekeepers for powerful prescription drugs.”

The agreement says CVS failed to provide sufficient internet connectivity for its pharmacists to access the prescription monitoring program, which tracks prescriptions, allowing health professionals to see whether someone has been given an inordinate amount of painkillers.

Public Health Commissioner Dr. Monica Bharel noted that starting in October every physician and prescriber will need to check the prescription monitoring program before prescribing opiates and over 79 percent of the state’s prescribers and pharmacists are on the program.

A new version of the PMP, known as the Massachusetts Prescription Awareness Tool, went live last month, and is intended to be easier to use and to link up with data from surrounding states.

Two people recovering from opioid addiction spoke at the press conference about how the medical profession enabled their addictions.

Natasha Harkins-Dube said while attending Beverly High School about a decade ago she took the prescription painkiller Percocet for “fun” and because she thought it was safe, as it had been prescribed to someone by a doctor, but it “took hold of me.” Harkins-Dube went to Recovery High School in Beverly, and wanted to stay sober, but after having her wisdom teeth pulled a dentist insisted she take Vicodin, another painkiller, and she took the entire prescription in one day. After swearing off drugs again and giving birth to her daughter, Harkins-Dube said, a doctor prescribed her Percocet and she got back into drugs, losing custody of the child.

Harkins-Dube said she has kicked drugs again, finding a support network and “spiritual solution,” and regained custody of her daughter. She will start at Boston University next week.

Rob Demeo said his addiction began after flipping a truck on Interstate 93 North in Andover in 2010 and suffering injuries that required extensive hand surgery.

“That car accident took my hand, but the prescription pill the doctor wrote? That prescription pill took my life. It took on a life of its own. It sent me from doctor to doctor trying to get another script. It was like my EZ Pass into active addiction,” Demeo said. He said, “It led me straight to IV use of heroin.”

Demeo said his doctors “didn’t explain much of anything to me” and he credited the Dimock Center in Roxbury with his recovery.

State lawmakers and Gov. Charlie Baker added new requirements this year for prescribers to receive an education in addiction.