CVS Health Limits Coverage of Opioids

Opioid abuse is a national health epidemic, with 115 Americans dying every day from an overdose, according to the Centers for Disease Control and Prevention (CDC).  In response, CVS Health has developed an initiative to curb this abuse and limit coverage of these pain management drugs. NRECA’s Group Benefit Plan, in consultation with its member advisory groups, has adopted the opioid policy as part of the prescription drug benefit.

CVS Health’s new limits align with the CDC’s latest guidelines and are designed to help ensure the safe use of opioids as pain management therapy, while encouraging conversations between the patient and his or her provider.

These limits apply to participants who are eligible for the NRECA prescription drug benefit and include limiting first fills of opioids to seven days and the quantity of opioid products per day.

CVS Caremark sent letters in December 2017 to participants who were currently prescribed an opioid to inform them of the new coverage limits on their medication.  Additionally, the company sent letters to providers of those affected participants requesting the provider adjust their patient’s therapy to meet the new coverage limits and informing them of prior authorization as an option for additional fills or larger quantities, as needed per patient.

Learn more about CVS Health’s new coverage limits on the pharmacy page in the BA Guide. Information about these prescription limitations has also been added to the participant-facing prescription drug benefit page on NRECA’s Employee Benefits website.

If you or your employees have questions about opioid prescriptions or the new prescription limits of these drugs, call CVS Caremark Customer Care at 888.796.7322.