Why Is CVS Paying $795K Fine to Massachusetts?

Disclaimer: The views and opinions expressed in this article are those of the author and do not reflect the official policy or position of Pharmacy Times.

CVS has just agreed to pay a $795,000 fine to Massachusetts for a past failure to give its pharmacists access to the state’s prescription monitoring program (PMP).

This comes amid other allegations that CVS pharmacies may have filled opioid prescriptions for MassHealth members who were supposed to be locked into certain locations by allowing them to be filled as cash prescriptions.

The current news reports about the fine appear strangely unclear about the nature of the violation or allegation of misconduct. For example, many of them say PMP access was an issue dating back to March 2013. Is CVS just resolving that issue now?

Other allegations seem foggy, as well. One reporter stated “certain CVS pharmacists failed to use ‘sound professional judgment’ when dispensing controlled substances.” Who made that assessment and on what grounds?

It’s true MassHealth can lock certain members into using one pharmacy, and pharmacies generally shouldn’t allow patients to pay cash to circumvent this barrier. But, if patients don’t present their MassHealth card, the pharmacy may have no means of knowing they’re members.

Finally, all news reports seem to mention that CVS will tighten its opioid dispensing policies. What does that mean, exactly? Will CVS enact different policies in Massachusetts than in other states? Does its current policy violate any existing statues or regulations? Is it less rigorous than say Walgreens’ or Rite Aid’s?

Let’s also address pharmacists’ predicament when it comes to filling opioid prescriptions. When I’m filling a prescription for a diabetes drug, for instance, I have a duty to ensure the dose and quantity are appropriate. But, what’s the appropriate dose and quantity for an opioid prescription? Why is it being used? How long has the patient been treated? Have they had any unusual circumstances to increase their pain?

The pharmacy knows none of these answers, and yet the pharmacist is supposed to determine whether or not the patient should receive the opioid. Yes, pharmacists have what’s known as a “corresponding responsibility” to ensure a prescription is being written for a legitimate medical purpose. But, when it comes to prescriptions for pain (or “pain”), it’s nearly impossible to guarantee every time.

The whole situation leaves me scratching my head and wondering what’s really going on. I don’t fault reporters for conveying incomplete information. Much of what’s odd about this situation would only appear as such to a pharmacist who’s worked in this industry for many years, and in Massachusetts in particular.

We who enter the health care profession know there are many obstacles to overcome. We know there are patients who will abuse the system, and we also know there are unscrupulous practitioners—both prescribers and pharmacists—who sadly seek to profit from addiction.

What we need more than anything in the midst of this opioid epidemic is the truth. We need to be honest about the real source of controlled substances and unrelenting in our efforts to limit illegitimate supply channels. We need aggressive treatment options for addicted patients, with ways to get them back into society, free from the chains of substance abuse. We need tough love (eg, heavy fines and imprisonment) for those who knowingly divert opioids and perpetuate this problem.

Surely, pharmacists can do better. We need to document our efforts to ensure patients who need opioids can get them, while making it harder for those gaming the system to succeed. Sometimes, this pits us against prescribers we’d prefer to be working with rather than against. I’ve personally encountered several physicians in my career who frankly didn’t seem to care about their out-of-control patients or prescribing. But, thankfully, most prescribers, like us, are concerned.

What isn’t helpful, in my opinion, is a $795,000 fine that leaves health care professionals wondering what really went wrong.