For more information
More people died from drug overdoses in the U.S. in 2014 than during any previous year on record, and at least half of all opioid overdose deaths involved a prescription opioid like Vicodin or OxyContin, according to the Centers for Disease Control. Nevada is no exception to this tragic trend, ranking among the top 15 states for lethal overdoses with 18.4 deaths per 100,000 residents. Clearly, the overuse and abuse of prescription drugs has evolved into a national epidemic and a public health emergency.
Insurers are in a unique position to make a difference as they have real-time access to all of a member’s claims for prescription medications that many pharmacists and doctors don’t. Prescribers may not be aware that their patient has overdosed or that a member is getting several prescriptions for the same drug or many, many other drugs from multiple doctors.
The research bears this out — even after overdosing, more than nine out of 10 of those patients continued to get prescriptions for opioids, according to a 2015 study published in the Annals of Internal Medicine. Seventy percent of patients who overdosed later received prescriptions from the same health care professional who prescribed narcotics before their first overdose.
Anthem Blue Cross and Blue Shield has a comprehensive suite of programs and resources to assist members and their physicians in managing opioid abuse and abuse-related conditions. With our recently launched Pharmacy Home Program, we are working to further reduce the inappropriate use of prescription drugs in Nevada by establishing one home pharmacy to more effectively coordinate care for at-risk members.
This pharmacy program, which began in April, focuses on a small but extremely high-risk segment of members who either are on large amounts of opioid medicines or have been getting narcotic prescriptions from three or more different doctors. Those who a have diagnosis or prescription history for HIV, sickle cell anemia, multiple sclerosis, cancer and hospice and palliative care are exempted from the program.
In addition to reducing the number of pharmacies used by the member, this program aims to also improve quality of care by helping to better coordinate care. The program focuses on use of prescription medications, both controlled — such as opioids and other painkillers and anti-anxiety drugs — and non-controlled substances to help decrease the risk of adverse drug interactions.
Collaborating with providers is a key part of the Pharmacy Home Program. Anthem notifies prescribers in writing of the decision to include the member in the program. The prescriber will also receive a three-month member prescription member history and an education piece on the advantages of one pharmacy to review with the member. Pharmacies will also be notified that the member has chosen them as their home pharmacy.
If the member does not change behavior as viewed in claim activity within 60 days of the first letter, the member will be mailed an enrollment letter requesting selection of a single pharmacy location to fill all medications, with a few exceptions, for a period of one year. If the member doesn’t pick a pharmacy, Anthem will designate one.
We know from our experience in Anthem’s Medicaid plans that efforts like this can result in large reductions in opioid prescriptions and lead to more appropriate treatment for substance abuse and pain management. After a similar plan was put into place at our Maryland Medicaid plan, two different studies of Anthem’s Maryland Medicaid plan showed a drop of opioid prescriptions of 28 percent, and a drop of emergency department visits by 21 percent while substance abuse treatment went up by 50 percent and pain management visits increased by 17 percent.
With nearly 550 drug overdose deaths in Nevada in 2014, we are in the midst of an opioid overdose epidemic. Anthem’s Pharmacy Home program is just one part of our overall strategy to help re-direct members to appropriate care, prevent addiction, and hopefully, prevent deaths and major medical problems from overdose and drug interactions.