Anthem Blue Cross and Blue Shield launches program to tackle inappropriate opioid and Rx drug use

Anthem Blue Cross and Blue Shield has launched the Pharmacy Home Program to help high-risk members in individual and employer-sponsored plans reduce addiction to opioids and other prescription drugs and improve drug safety and healthcare quality by choosing one home pharmacy to fill their prescriptions.

In Kentucky deaths from drug overdose went up 4.2 percent between 2013 and 2014, according to the National Vital Statistics System.  With 24.7 deaths per 100,000 people, Kentucky has the fourth highest death rate nationally of drug overdose deaths in 2014. 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 Divya Cantor, MD, senior medical officer for Anthem in Kentucky. “Health insurers are uniquely positioned to help improve prescription drug safety and healthcare quality as we 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. 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,” said Dr. Cantor. “Because many medical information systems are not integrated, prescribers may not be aware that a member has overdosed or that a member 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 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 Anthem Medicaid plans 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. Cantor. “This program is just one part of our overall strategy to help prevent addiction, re-direct members to appropriate care, and hopefully, prevent deaths and major medical problems from overdose and drug interactions.”