Several health insurers have already launched programs to reduce the number of opioid prescriptions.A month after President Trump declared the opioid epidemic a public health emergency, a group of health insurers have banded together to confront a crisis that has taken more than 183,000 lives between 1999 and 2015.
16 health insurance payers including Aetna, Anthem, UnitedHealth Group, and Cigna announced their support of eight guidelines for opioid addiction treatment in early November. Among the recommendations are immediate access to substance abuse therapy and trained professionals, screening for opioid addiction in all medical settings, coordinated care for physical and mental illness, and long-term follow-up treatment. Also spearheading the effort are Gary Mendell, Founder and CEO of Shatterproof, a nonprofit organization formed to combat addiction, and Dr. Thomas McLellan, Former Deputy Director of the Office of National Drug Control Policy.
“We believe substance use disorders are manageable chronic diseases that should be treated with evidence-based approaches and handled with the same urgency of other chronic diseases, such as diabetes, cancer and heart disease,” said Chris Hocevar, President of Strategy, Segments and Solutions of Cigna.
States, too, have launched initiatives to deal with the crisis with the support of the health insurance industry. In October, Ohio Attorney General Mike DeWine established a task force of eight insurers including Aetna, Anthem, Buckeye Health Plan, CareSource, Medical Mutual, Molina Paramount, and United Healthcare to explore ways to reduce the number of opioid overdose deaths in the state — a total that reached more than 4,000 last year.
What Insurers Are Doing
Several health insurers have already instituted plans to curtail opioid addiction by limiting painkiller prescriptions. Aetna, for example, intends to cut opioid prescriptions to its members in half by 2022. It now covers medications that manage painkiller withdrawal symptoms, as well.
Similarly, Cigna aims to reduce opioid prescriptions by educating doctors on pain-management techniques that don’t require opioids. The insurer set a goal of lowering its members’ prescription opioid usage by 25% from the level charted in 2015. Between April 2016 and April 2017, Cigna reported a 12% reduction.
Kaiser Permanente also takes an educational approach with its doctors and pharmacists. In Southern California, the insurer instructed physicians on safe opioid practices, and urged pharmacists to flag high-risk prescriptions. The measure has resulted in a 72% drop in opioid remedies prescribed for non-cancer and non-hospice patients in Southern California.
Reimbursement Lock-In Programs
One method increasingly employed by insurers to clamp down on painkiller prescriptions is what is termed a reimbursement lock-in program. Since many patients with opioid addictions obtain prescriptions from several doctors, a physician may prescribe a medication without knowing that another physician has done the same. A Wall Street Journal article noted that of the 98 million Americans issued opioid prescriptions each year, nearly 3 million procure the drug from between five to 20 different doctors.
An insurer can spot a “doctor shopper” by reviewing the separate billings for the medications. In response, the healthcare provider can mandate that it will only pay for the prescription if it’s supplied by a single medical professional. Both Anthem and UnitedHealth Group have initiated programs that monitor opioid prescriptions and “lock in” members to one prescriber or pharmacy.
About 15% of Anthem members now use a single pharmacy after being identified for possible misuse. UnitedHealth Group supplements its reimbursement lock-in program by intervening with any doctor that issues a higher than normal number of opioid prescriptions. This initiative yielded a 41% decrease in opioid prescriptions to its members in 2015 and slashed the number of doctors prescribing opioids by 45%.
As more attention is focused on combating opioid addiction, health insurers stand at the front lines of the battle because of their position as healthcare providers and payers. Fortunately, the industry has advanced methods to help patients overcome their disease.