Health care

Anthem reduces prescribed opioid use among its members by 15%

By Staff

South Portland-based Anthem Blue Cross and Blue Shield in Maine reported Wednesday that opioid prescriptions for its individual and employer-sponsored members dropped by 15% in the past year.

Anthem stated in its news release that the primary goal of the quantity limits was to prevent inadvertent addiction and opioid use disorder and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines.

It added that these Maine initiatives contributed significantly to its parent company meeting a national goal to reduce opioids filled at the pharmacy by 30% compared to the opioid prescription peak in 2012.

“This misuse of opioids continues to be a serious issue here in Maine and we are committed to making a significant difference to our members,” said Dan Corcoran, president of Anthem Blue Cross and Blue Shield. “We believe these changes in pharmacy policy, in addition to a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

Last year Maine experienced 376 overdose deaths, the majority of them from opioids.

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The pharmacy policy changes are part of Anthem Blue Cross and Blue Shield’s holistic approach to prevention, deterrence and treatment to reduce the impact of this epidemic. To help ensure members have access to comprehensive evidence-based care, Anthem also is committed to helping its affiliated health plans double the number of members who receive behavioral health services as part of medication-assisted therapy, drug and talk therapy, for opioid use disorder by 2019.

Here's how Anthem reduced opioid prescriptions among its members in Maine

Anthem Blue Cross Blue Shield took the following steps designed to help ensure clinically appropriate use of opioids and to proactively prevent the development of opioid use disorder:

  • For short-acting opioids, initial prescriptions are limited to seven days. Members can only receive a maximum 14 days’ supply for short-acting opioids in a 30-day period without additional authorization, consistent with CDC Guidelines. The quantity limits began rolling out in October, 2016, for individual short-acting opioids, with the limit on the most popular drug, hydrocodone-acetaminophen, taking effect in July.
  • For all long-acting opioids, prior authorization was put into place in September 2016 for initiation of therapy. Quantity limits for long-acting opioids have existed for many years, with exceptions for those have terminal or chronic illness.
  • Pharmacy Home programs exist for individual, employer-sponsored, Medicare and Medicaid members that can assign members to one pharmacy and/or one provider for their opioid prescriptions. The program allows doctors to better monitor access of opioids and helps ensure members are receiving counseling and mental health support.
  • Providers who receive member electronic dashboards are notified when a member is at greater risk for developing opioid use disorder — such as prescriptions from several providers or pharmacies, or when the member has prescriptions for opioids, muscle relaxants and benzodiazepines at the same time.
  • Providers are alerted of additional controlled substance use concerns and associated emergency room or urgent care use through letter, including when the member has prescriptions for both Suboxone and opioids or on persistent high doses of opioids. 
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