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AHIP: 25% of Opioid Prescriptions Top CDC Dosage Guidelines

With one quarter of opioid prescriptions above CDC dosage guidelines, AHIP provides payers with strategies to minimize patient safety risks.

AHIP provided payers with data and guidelines on opioid patient risks

Source: Thinkstock

By Thomas Beaton

- An AHIP retrospective analysis of claims data found that 25 percent of opioid prescriptions were above CDC dosage recommendation and provides a basic snapshot of problematic areas where payers could minimize patient safety risks related to opioids.

Forty percent of chronically ill beneficiaries were prescribed a benzodiazepine treatment alongside an opioid prescription, which could create negative drug interactions. Just one percent of beneficiaries underwent a urine drug test before being prescribed an opioid.

AHIP published the analysis as an initial benchmark as part of its STOP Initiative, which is aimed at helping health plans adopt clinical guidelines for reducing patient safety risks from opioid overuse or misuse.

Dr Richard Bankowitz, Chief Medical Officer of AHIP, believes that these initial results will help drive success in the STOP initiative and foster collaborative efforts to reduce opioid safety risks.  

“We can’t truly measure our progress until we know where we’re starting,” Bankowitz said in a press release. “These initial results will help ensure we’re making a meaningful and measurable impact as we work hand-in-hand with hospitals, physicians, patients and their families to stop this epidemic.”

AHIP provided a number of strategies that hope to help payers focus on actionable ways to address opioid safety risks. These strategies include incorporating therapy-based benefits into plan benefits, using provider engagement to communicate safety risks, and implementing addiction treatment services into health plans.

Health plans can start addressing opioid risks by using prevention-based benefits and techniques to minimize risks before a patient has opioid access, AHIP said.

Payers can leverage physical therapy benefits and non-opioid medications to treat pain before providing opioids. Payers should encourage providers to prescribe opioids only as a last resort if suitable alternatives are available.

Additionally, payers should take it upon themselves to educate and engage providers about CDC guidelines, such as using the lowest possible opioid dose in treatment. Engagement strategies should also include beneficiary education about the dangers of opioid abuse.

Payers may benefit from leveraging medical management tools and procedures like step therapy and prior authorizations to limit access to dangerous opioids, AHIP said.

Payers could also share pharmacy information with providers in order to collaborate on how to best implement an opioid abuse intervention. Engaging in data analytics using pharmacy information could help to identify when a benzodiazepine has been prescribed along with an opioid.

AHIP suggests that payers can facilitate opioid addiction treatment by incorporating medication assisted therapy (MAT), counseling, and recovery support into member benefits.

Payers can have a strong impact on treatment by incorporating behavioral therapy, peer support services, rehabilitation and detox services, and cognitive care benefits into health plans, according to AHIP.

“Because individuals struggling with addiction often have other chronic medical and behavioral health conditions, treatment for opioid use disorder must be customized and coordinated to ensure the best possible opportunity for recovery,” AHIP said.

Payers can enhance their opioid abuse treatment and recovery strategies by partnering with legal organizations, community health programs, and pharmacies that administer MAT treatments like naloxone and buprenorphine.

The analysis and strategies are only the first step in AHIP’s efforts to combat opioid abuse risks from clinical interactions between patients and the healthcare system. The group will continue to analyze the efforts of their health plan groups and share those efforts to develop stronger insights.

“The STOP Measure methodology has been shared with insurance providers nationwide, who may apply it to measure their own opioid prevention and management efforts,” AHIP said.  

“In the coming months, results from their assessments will be gathered and the AHIP Opioid Work Group (a group of 40 health plan collaborators) will establish and share key learnings for tackling the opioid crisis.”


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