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Attorney General Kilmartin Urges PBMs to Follow CVS Lead and Implement Opioid Mitigation Programs

Attorney General Peter F. Kilmartin has joined with a bipartisan group of attorneys general from across the country in letters to 15 health care companies that provide pharmacy benefit management (PBM) services encouraging the companies to implement programs to mitigate prescription opioid abuse.

The attorneys general also sent a letter to the president and CEO of CVS Health Corporation applauding the company's recent program that automatically enrolled all commercial, health plan, employer and Medicaid clients in an opioid abuse mitigation program.

Last month, Attorney General Kilmartin praised CVS for its commitment to addressing the opioid epidemic saying, "CVS Health recognizes that to effectively tackle and defeat the opioid epidemic in this country, all stakeholders need to work together in a coordinated effort."

Kilmartin urged others to follow the lead taken by CVS. "If we are going to effectively end the opioid epidemic in this country, we need everyone to step up to the plate, including pharmacy benefit managers. These healthcare companies have a social and corporate responsibility to enact policies that benefit their clients and the greater community."

In their letters to the PBMs, the attorneys general asked that the companies adopt similar measures as CVS, including limiting to seven days the supply of opioids dispensed for certain acute prescriptions for patients who are new to the therapy, limiting the daily dosage of opioids dispensed based on the strength of the opioid, and requiring the use of immediate-release formulations of opioids before extended-release opioids are dispensed. The CVS program's requirements are similar to the opioid prescribing guidelines recently issued by the Centers for Disease Control and Prevention (CDC).

The multistate PBM letters were sent to:

o Argus Health Systems, Inc. o Benecard Servies LLC o Envision Pharmaceutical Services LLC o Envolve Health o Express Scripts, Inc. o Humana, Inc. o Magellan Rx Management o MedImpact Healthcare Systems, Inc. o Navitus Health Solutions LLC o OptumRX , Inc. o PerformRx o Prime Therapeutics, Inc. o ProCare Rx o RxAdvance o WellDyneRx

"While there are no doubt additional measures that pharmacy benefit managers could take to combat prescription opioid abuse, we believe over-prescribing of opioids could be curtailed by the implementation of a CVS-type program," the attorneys general wrote.

"The opioid epidemic is the most pressing public health crisis our country faces," the attorneys general wrote. "It affects every state and has a devastating impact on communities tearing apart families and stretching the budgets of local law enforcement and first responders as they do the difficult work on the front lines. For our part, attorneys general are pooling resources and coordinating across party lines to address the crisis."

Opioids, both prescription and illicit, are now the main driver of drug overdose deaths nationwide. According to CDC, opioids were involved in 33,091 deaths in 2015, and opioid overdoses have quadrupled since 1999. In Rhode Island, 336 individuals died from drug overdoses last year.

In addition to Attorney General Kilmartin, those joining today's letters include attorneys general from Alabama, Arizona, Connecticut, Delaware, Georgia, Indiana, Iowa, Louisiana, Maine, Michigan, Montana, New Hampshire, South Carolina, Utah, Virginia, West Virginia, the District of Columbia and the U.S. Virgin Islands.

Also last month, Attorney General Kilmartin announced that a bipartisan coalition of attorneys general sought documents and information from manufacturers and distributors of prescription opioids as part of multistate investigations into the nationwide opioid and whether manufacturers and distributors engaged in unlawful practices in the marketing, sale, and distribution of opioids.

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