Pre-Authorizations, Rx Limits Cut Opioid Abuse by 30% Nationwide

August 24, 2017 - Anthem BlueCross BlueShield (BCBS) organizations across the country collectively pledged to lower opioid abuse by 30 percent, and the company as a whole reached that goal two years ahead of schedule according to a press release.

Declared a national emergency at the federal level, opioid abuse is a significant healthcare concern that payers have to help address in order to protect their beneficiaries. Anthem set opioid quantity limits based on CDC guidelines and expected to reach reduction goals by 2019.

The health payer cited that exceptional initial implementation of the quantity limits early on led strong opioid reductions in the first year.

In 2016, Anthem BCBS Medicaid plans reduced opioid quantities by 29 percent in Virginia, 22 percent in Maryland, and 9 percent in Georgia as employer-sponsored; meanwhile, individual plans decreased opioids by 23 percent in Nevada and 17 percent in both Connecticut and Wisconsin.

Anthem’s executive leaders recognized that improving beneficiary safety related to opioid abuse is an organizational responsibility for payers to help curb the nationwide epidemic.

“Anthem believes all insurers have a responsibility to do what we can to address this health epidemic, and we are committed to making a significant difference to our health plan members,” said Anthem Vice President of Behavioral Health Sherry Dubester, MD, MS, who leads the company’s effort to combat opioid abuse.

“We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, reduce and more effectively treat opioid use disorder among our members,” she continued.

Anthem used multiple strategies based on whether prescribed substances were used for long- or short-term treatment.

Anthem limited initial prescriptions for short-acting opioids to seven days. Anthem’s members can only receive a maximum a 14-day supply for short-acting opioids in a 30-day period without additional authorization.

These quantity limits began rolling out in October 2016, for individual short-acting opioids. Limits on the most popular opioid-based drug among Anthem beneficiaries seeking treatment — hydrocodone-acetaminophen — took effect this July.

For long-acting opioids, prior authorization was put into place in September 2016 for beneficiaries who began therapeutic treatment. Anthem said that these limits for long-acting opioids have existed for many years, with exceptions for those have terminal or chronic illness.

Also, Anthem used pharmacy programs that allowed providers to monitor opioid use and frequency of prescription requests to mitigate substance abuse.

Pharmacy home programs exist for individual, employer-sponsored, and Medicare Anthem BCBS members that assign members to one pharmacy and/or one provider for their opioid prescriptions. This program allowed doctors to improve their oversight of opioid access of opioids, and ensured that members are received counseling and mental health support, Anthem said.

Other pharmacy programs allowed providers who accessed member electronic dashboards to receive notified when Anthem members had a higher risk to develop an opioid-abuse disorder. Risk notifications were sent to provides when members had prescriptions from several providers or pharmacies, or when a member had prescriptions for opioids, muscle relaxants and benzodiazepines at the same time.

Providers also received alerts about additional controlled substance use concerns and associated emergency room or urgent care use through letters. These alerts included when a member had prescriptions for both Suboxone and opioids, or persistent high dose prescription of opioids.

Anthem BCBS leaders in Connecticut and New York announced that these programs are working in their states as well, and are examples of how the payer implemented universal strategies to address a massive health problem affecting the entire country.

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” said Anthem BCBS of Connecticut President Jill Hummel. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” added Empire BCBS President Larry Schreiber. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”