Anthem pharmacy policy changes help to reduce prescribed opioid use

MANCHESTER — Prescribed opioids for members of Anthem Blue Cross and Blue Shield in New Hampshire have dropped by 20 percent for individual and employer-sponsored members in the past year.

Limiting coverage of opioids to seven days to those newly starting opioids, requiring provider prior authorization and directing those most at risk for opioid use disorder to one pharmacy have all been a factor in reducing opioid prescriptions. 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. Anthem Blue Cross and Blue Shield and its affiliate plans contributed significantly to its parent company meeting a national goal to reduce opioids filled at the pharmacy by 30 percent since the opioid prescription peak in 2012.

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 Blue Cross and Blue Shield 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.

“As a health insurer, we have a responsibility to do what we can to address this public health crisis that has greatly impacted New Hampshire,” said Lisa Guertin, president of Anthem Blue Cross and Blue Shield. “We are committed to making a significant difference to our members and 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.”

The New Hampshire Office of the Chief Medical Examiner is reporting 190 overdose deaths so far this year. Last year, the state experienced 486 overdose deaths.

In addition to implementing changes in pharmacy policy, Anthem Blue Cross and Blue Shield’s efforts to help combat this problem has included building treatment capacity by expanding Anthem’s network of substance use disorder providers and partnering with the New Hampshire Medical Society to train more than 180 providers in providing medication-assisted treatment.

The Anthem Blue Cross and Blue Shield Foundation has strengthened its support for local organizations providing assistance and treatment for those struggling with substance use disorder, including a $75,000 grant to Safe Station. Safe Station is a collaborative effort between the city of Manchester, the Granite United Way, Manchester Fire Department, Manchester Health Department and Serenity Place to address the needs of those seeking immediate services for substance use disorders by providing a starting point — available 24 hours a day ­— to aid in treatment and recovery. Anthem’s support is allowing Safe Station to strengthen and expand its prevention efforts aim at the city’s youth.

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-day 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.