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After AG probe, CVS adopts new opioid rules

Attorney General Maura Healey holds a CVS prescription bottle as she announced in a first-in-the-nation settlement on Thursday. John Tlumacki/Globe Staff

Pharmacists working in the 350 CVS drug stores in Massachusetts will have to consult a database of prescriptions before dispensing powerful painkillers under a first-in-the-nation agreement designed to help stem the opioid crisis.

The pact, the result of an investigation by Attorney General Maura Healey into CVS stores improperly dispensing drugs to high-risk patients, emerges as opioids have left thousands dead across New England.

“Pharmacies are on the front lines of this epidemic,” Healey said at a news conference Thursday at the Dimock Center, a community health and human services agency in Roxbury. “They are the gatekeepers for powerful prescription drugs, powerful prescription opioids, that have helped fuel this current crisis.”


Under the agreement, CVS pharmacists will have to check the state’s Prescription Monitoring Program, which tracks every opioid prescription and can reveal when a patient is visiting multiple doctors or pharmacies.

The settlement represents the second time in recent weeks that CVS Pharmacy, the largest drug store chain in the state and the nation, has run afoul of authorities over opioid dispensing. In June, CVS agreed to pay $3.5 million after federal investigators found that pharmacists in Massachusetts and New Hampshire filled hundreds of forged prescriptions, most for addictive painkillers.

A Healey spokeswoman said the federal case was unrelated to the attorney general’s settlement, finalized Tuesday.

State law does not require pharmacists to consult the prescription database, although doctors, nurses, and others who write opioid prescriptions must do so. But the agreement with CVS is legally binding.

CVS also agreed to pay the state $795,000, of which $500,000 will be used to address opioid addiction, which claimed 1,500 lives last year in Massachusetts.

CVS said that the company “recognizes the importance of the state’s Prescription Monitoring Program as a tool to detect and prevent the abuse and misuse of controlled substances” and that the agreement “is consistent with the company’s ongoing commitment to provide enhanced policies, procedures, and tools” to help pharmacists tell whether prescriptions are legitimate.


Healey’s office negotiated the commitment to settle a complaint from MassHealth, the state’s Medicaid program. MassHealth reported that CVS pharmacies had improperly dispensed opioids to patients who had been flagged as high risk because they receive prescriptions for large quantites of opioids. Such patients are required to fill prescriptions at only one pharmacy.

Former opioid addict Rob Demeo told his story Thursday as Healey looked on.John Tlumacki

In about 40 instances between 2010 and 2016, these high-risk patients presented a prescription that was rejected by MassHealth. Instead of turning the patient away, the CVS pharmacists accepted cash payments and dispensed the drugs, in violation of rules.

While investigating the complaint, representatives of the attorney general discovered that pharmacists were not routinely checking the prescription database, Healey said. In fact, before March 2013, in many stores, they couldn’t — because Internet access was inadequate.

Healey said the 1,200 CVS pharmacists in Massachusetts would now consult the database for all customers, not just those in MassHealth. The pharmacy has agreed to rewrite its policies by Sept. 30 and train pharmacists in using and responding to the database.

“CVS pharmacists armed with this kind of information can help us stop . . . prescription opioids from getting into the hands of people struggling with addiction or from getting into the hands of people who would look to prey upon others who are vulnerable by selling and marketing these drugs on the street,” Healey said.


The attorney general said her office plans to work with other pharmacies to ensure they, too, have policies in place for use of the Prescription Monitoring Program, known as the PMP. She called the CVS agreement a positive model.

Walgreens, another major pharmacy chain in Massachusetts, gives pharmacists access to the prescription monitoring programs in states that have them, encourages its use, and in some circumstances requires pharmacists to check the tracking system before dispensing certain prescriptions, said spokesman Phil Caruso.

Asked whether CVS will require pharmacists in other states to consult the Prescription Monitoring Program, spokesman Mike DeAngelis said the company follows each state’s regulations and “it is our expectation that our pharmacists use their professional judgment to determine when to check the PMP.”

Karen Horbowicz, president of the Massachusetts Pharmacists Association, said she found it “a little disappointing” when she heard of Healey’s allegation that CVS pharmacists were not using the Prescription Monitoring Program.

“Most of the pharmacy colleagues that I’ve spoken to know what the PMP is, utilize it, and certainly see the value in it,” said Horbowicz, who works at an independent pharmacy in Cambridge.

A few years ago, she said, a pharmacist consulting the tracking system noticed that a patient was turning in multiple prescriptions in short intervals from a single physician. After contacting the doctor, the pharmacist realized the patient was handing in computer-generated forgeries. The pharmacist called the police and the patient was arrested in the pharmacy.


The association has developed standards for dispensing controlled substances that advise pharmacists to consult the drug tracking system if they don’t have a relationship with a patient or prescriber, or if they see anything suspicious, such as two patients from the same address showing up with the same prescription in a day.

Michael Levenson of the Globe staff contributed to this report. Felice J. Freyer can be reached at felice.freyer@globe.com.