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Pharmacy Programs That Tackle Inappropriate Opioid and Rx Drug Use Can Improve Drug Safety and Health Care Quality

ELV | May 25, 2016

Pharmacy Programs That Tackle Inappropriate Opioid and Rx Drug Use Can Improve Drug Safety and Health Care Quality

Insurers can and should play a role in helping to reduce the rate of drug overdose and improving quality of care. That’s why Anthem, Inc.’s affiliated health plans have launched a program to help reduce addiction to opioids and other prescription drugs and improve drug safety by enrolling high-risk members in individual and employer-sponsored plans in the Pharmacy Home Program, which limits drug coverage to one member-chosen home pharmacy.

More people died from drug overdoses in the United States in 2014 than during any previous year on record, according to the Centers for Disease Control, with nearly half a million people in the United States dying from drug overdoses between 2010-2014. Sixty percent of drug overdoses resulting in death involved narcotics. At least half of all opioid overdose deaths involve a prescription opioid.

“Clearly, the overuse and abuse of prescription drugs has evolved into a national epidemic and a public health emergency,” said Colleen Haines, Anthem vice president of clinical and specialty pharmacy. “Health insurers, such as Anthem, are uniquely positioned to help improve prescription drug safety, health care quality and outcomes as they have real-time access to information on medication use to determine if members are using multiple prescribers or several pharmacies to obtain their medications, which often correlates with addictive behavior.”

The Pharmacy Home Program, which began on April 1 with distribution of letters to eligible members, focuses on a small but extremely high-risk segment of members in Anthem health plans in 14 states. 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.

Even after overdosing on opioids – a class of painkillers — more than nine out of 10 people continued to get prescriptions for them, according to a 2015 study published in the Annals of Internal Medicine. And, some patients went on to suffer another overdose. Seventy percent of patients who overdosed later received prescriptions from the same health care professional who prescribed opioids before their first overdose.

“Collaborating with prescribers is key,” Haines said. “Because many medical information systems are not integrated, prescribers may not be aware that their patient has overdosed or that a patient is getting several prescriptions for the same drug or many, many other drugs from multiple doctors.”

The Pharmacy Home Program notifies prescribers in writing of the decision to include the member in the program. The prescriber will also receive a three-month member prescription history and an education piece on the advantages of one pharmacy to review with the member.

Members with increased safety risk and candidates for the Pharmacy Home Program meet these criteria within a 90-day period:

Filled five or more controlled-substance prescriptions, or filled 20 or more prescriptions, not limited to controlled substances
Visited three or more health care providers for controlled substance prescriptions, or 10 or more providers not limited to controlled substances
Filled controlled substances prescriptions at three or more pharmacies, or filled prescriptions for 10 or more pharmacies not limited to controlled substances.

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.

“We know from Medicaid programs that efforts like this can result in large drops in opioid prescriptions and lead to more appropriate treatment for substance abuse and pain management,” said Dr. Sherry Dubester, Anthem vice president of behavioral health and clinical programs. “Programs like these are just one part of an overall strategy to help prevent addiction, re-direct consumers to appropriate care, and hopefully, prevent deaths and major medical problems from overdose and drug interactions.”

About Anthem, Inc.

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 72 million people served by its affiliated companies, including more than 39 million enrolled in its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies.