Payers Leverage Data, Wellness Benefits to Address Opioid Abuse

January 16, 2018 - Providing substance use disorder (SUD) treatment options and making investments in beneficiary drug safety is a critical component of wellness programs, considering that the White House deemed opioid abuse a public health emergency in 2017.

In 2016, opioid abuse was responsible for 42,000 deaths. Forty-percent of all deaths from an opioid overdose were from either a legally or illegally obtained prescription drug, according to data from the CDC.

A growing number of Americans are at risk for opioid abuse, which has led commercial payers to incorporate extensive SUD benefits into beneficiary wellness programs. A strong wellness program can promote positive health behaviors that keep individuals healthy and support proactive wellness-decision making.

Recently, commercial payers have been leveraging strategic investments, educational programming, and prescribing regulations to address opioid and SUD-related wellness of their members.

WellCare of Kentucky invests $35,000 to combat lethal opioid abuse

READ MORE: How Payer Philanthropy Can Address Social Determinants of Health

WellCare of Kentucky announced investments of $35,000 to support addiction recovery services in the city of Louisville and out to Eastern Kentucky. $10,000 will go to the Healing Place in Louisville while the remaining $25,000 will be distributed to Addiction Recovery Care (ARC) services in eastern region of the state.

The decision came after data from the Kentucky Office of Drug Control Policy found a 266 percent increase in heroin overdoses from 2013 to 2016.

"Our interest is in saving lives and improving the health of people in Kentucky," said Bill Jones, president of WellCare of Kentucky. "Opioid abuse is life-threatening – that's obvious. But it, and other addictions, also prevents entire families from living healthy lives and meeting their full potential."

The investment allows WellCare of Kentucky, the largest Medicaid managed care organization in the state, to address medical and social vulnerability to opioid abuse.

Aetna waives narcan co-pays to address opioid treatment cost concerns

READ MORE: Outcomes-Based Contracts Offer Payers New Pharmaceutical Options

Aetna has also taken steps to address opioid abuse by waiving narcan co-pay amounts and putting limits on the length of opioid-based prescriptions. Leaders at Aetna cited cost as a socioeconomic barrier to a potentially life-saving drug.

The decision came after 76.6 percent of members did not pick up a narcan prescription if co-pays were anywhere from $100 to $150. Prescription abandonment rates fell to just under 50 percent when co-pays were lowered to the $40 to $50 range.

“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” said Harold L. Paz, MD, MS, executive vice president and chief medical officer of Aetna. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”

BCBS divisions develop and invest in drug safety programs

BCBS of California has had success in reducing opioid use by 32 percent after implementing their own drug safety program.

READ MORE: Expanding Air Ambulance Service May Help Payers Control Costs

A program called the Narcotic Safety Initiative (NSI) used evidence-based decision making and prescription monitoring to help reduce chronic opioid abuse by 17.4 percent and decrease high-dose opioid users by 46.8 percent.

"While we are looking to reduce first-time use of opioids among our members when other treatment options can be as or more effective, we are also helping doctors and members aim for the lowest possible dose for those already on chronic opioid therapy," said Salina Wong, PharmD, Blue Shield's director of clinical pharmacy programs.

BCBS divisions throughout the country are also leveraging engagement tactics to develop opioid-related wellness programming that reaches high-risk populations.

BCBS of Tennessee found success in a community-based prescription take-back program that recovered 34 tons of unused prescriptions. The payer’s Count It! Lock It! Drop It! (CLD) program supported community education and outreach through a $1.3 million grant which taught individuals how to properly dispose of unused opioids.

Dr. Andrea Willis, senior vice president and chief medical officer for BCBS of Tennessee, said that programs like CLD support the payer’s goals of improving opioid wellness among vulnerable beneficiary groups.

“We made a commitment to play a significant role in the fight against opioid abuse in Tennessee, and we felt that helping CLD expand its program to areas across the state hit hard by this epidemic could have a major impact in getting prescription pain medications out of circulation,” Willis said. “The program’s results are extremely impressive, and we are proud to have played a part in helping it grow and expand.”

BCBS of Michigan is working on several strategic opioid-wellness initiatives including quantity limits on opioid prescriptions, coordinated care efforts with providers to reduce opioid abuse, coordinated prescription reviews, and a toolkit that educates providers on prescribing best-practices.

BCBS of Michigan CEO Dan Loepp praised recently passed state legislation that tightens opioid prescriptions, which falls in line with the payer’s objectives for improving SUD and opioid wellness.

“As Michigan’s largest health insurer with a strong social mission, Blue Cross Blue Shield of Michigan shares the concern over the crisis and we are also expanding our efforts to prevent addiction and overdose deaths in Michigan,” Loepp said.

“We have significant efforts underway to combat the opioid epidemic by enhancing awareness, and through partnerships with physicians and public health advocates and officials.”