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AMA Letter to Walmart CEO on Opioid Policy

Thursday, August 23, 2018  
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The below is excerpted from an August 16, 2018, letter from the AMA to Walmart CEO and President Doug McMillon

Doug McMillon
President and Chief Executive Officer       
Walmart, Inc.
702 SW 8th St.
Bentonville, AR 72716
Marybeth Hays
Executive Vice President of Consumables
and Health and Wellness
Walmart, Inc.
702 SW 8th St.
Bentonville, AR 72716 

Dear Mr. McMillon and Ms. Hays:

On behalf of the American Medical Association (AMA) and our physician and medical student members, I am writing to share our concerns resulting from new Walmart pharmacy policies. The concerns specifically focus on the new policy that was announced in May whereby “Walmart and Sam’s Club will restrict initial acute opioid prescriptions to no more than a seven-day supply, with up to a 50 morphine milligram equivalent maximum per day.” (See https://news.walmart.com/2018/05/07/walmart-introduces-additional-measures-to-help-curb-opioid-abuse-and-misuse) There are three main reasons for our concern:

First, contrary to the news release you issued, this policy is not in alignment with the Centers for Disease Control and Prevention’s (CDC) Guideline for Prescribing Opioids for Chronic Pain. (See https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm) The CDC itself has emphasized the voluntary nature of the guidelines and argued against using them as a prescriptive standard (Continued)

Second, the new policy threshold leaves many questions unanswered. The AMA was pleased that Walmart representatives sat down with us in March of this year along with representatives from the AMA Opioid Task Force, including the Arkansas Medical Society. ... In light of the March meeting, we were greatly surprised to learn of your new corporate policy based on a hard threshold of 50 MME or seven days for an initial opioid prescription for acute pain. In the spirit of collaboration from our March 1 meeting, AMA staff has repeatedly attempted to learn more from Walmart representatives, including:
• What communication about the new policy will be shared with physicians?
• How will Walmart pharmacists implement the policy when it is not clear if a prescription is for acute or chronic pain?
• How will Walmart pharmacists adjudicate a prescription that is for more than seven days or more than 50 MME?
• Will Walmart pharmacists be bound by the new corporate policy, or will they have the professional obligation and flexibility to review prescriptions based on their corresponding responsibility under the Controlled Substances Act?
• If a state law has a threshold that is above the new corporate policy, will Walmart abide by the state law or substitute its corporate policy instead?

Third, as we have done in Congress, state legislatures and other venues across the country, we feel it necessary to point out that the focus on reducing the supply of opioid analgesics may be helpful to reduce diversion, but it will not, by itself, reverse the nation’s opioid epidemic. Walmart’s new corporate policy will almost certainly have two direct effects: it will reduce the supply of opioid analgesics, but it will also cause patients with pain to have increased suffering.  (Continued)

We stand ready to work with Walmart and all stakeholders to help end the nation’s opioid epidemic. Please contact the AMA’s Daniel Blaney-Koen, JD, Senior Legislative Attorney at daniel.blaney-koen@ama-assn.org or (312) 464-4954 to continue this important discussion.

Sincerely,
James L. Madara, MD

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