Indianapolis – Anthem, Inc. is committed to supporting policy changes that help reduce, prevent and deter opioid use disorder, as well as those that help consumers better access treatment. As part of that commitment, its affiliated health plans just reached the company’s collective goal of reducing prescribed opioids filled at pharmacies by 30 percent during the past five years.
The health plans were some of the first to limit coverage for short-acting opioid coverage to seven days for all individual, employer-sponsored and Medicaid members beginning new opioid prescriptions. The policy does not apply to those who have cancer or sickle cell anemia or those who are receiving palliative care.
The goal was originally expected to be achieved by 2019. The primary reason for the quantity limits was to prevent accidental addiction and opioid use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines.
Anthem also evaluated reductions based on the past year when its health plans accelerated health policies in various states and plans. In the past year alone, plans demonstrated large decreases in opioid use. For example, Medicaid plans showed a 29 percent reduction in Virginia, 22 percent reduction in Maryland, and a 9 percent reduction in Georgia while employer-sponsored and individual plans decreased opioids by 23 percent in Nevada, 17 percent in Connecticut, and 17 percent in Wisconsin.
“Anthem believes all insurers have a responsibility to do what we can to address this health epidemic, and we are committed to making a significant difference to our health plan members,” said Dr. Sherry Dubester, Anthem vice president of behavioral health, who leads the companywide effort to impact the opioid epidemic. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, reduce and more effectively treat opioid use disorder among our members.”
The opioid crisis was declared a national emergency by President Trump earlier this month. Drug overdose is the leading cause of accidental death in the U.S. exceeding car crashes and guns.1 From 2014 to 2015, drug overdose deaths increased by 5,349, or 11.4 percent, signifying a continuing trend observed since 1999, according to the Centers for Disease Control and Prevention. “We’re hoping our policies can help prevent consumers from developing opioid use disorder by carefully limiting coverage on quantities for short-acting opioids and requiring prior authorization from their prescriber to ensure a clinical need for long-acting opioids,” said Colleen Haines, Anthem vice president of clinical and specialty pharmacy. “We continue to explore additional ways to help ensure clinically appropriate use of opioids, and help prevent inadvertent addiction and opioid use disorder.”
Anthem affiliated health plans 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 days’ supply for short-acting opioids in a 30-day period without additional authorization, consistent with CDC guidelines. The Anthem quantity limit changes 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 who 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 a letter, including when the member has prescriptions for both Suboxone and opioids or is on persistent high doses of opioids.
To set its 2019 pharmacy goal, Anthem considered the number of opioids prescribed, as well as their dosing, to research morphine equivalents dispensed from 2012, the peak year for opioid prescription fills. Since then, Anthem’s policies have contributed to a reduction of 31 percent and Anthem has updated its goal to achieve a 35 percent reduction by 2019.
The pharmacy policy changes are part of Anthem’s holistic approach to prevention, treatment and deterrence to reduce the impact of this epidemic. To help ensure members have access to comprehensive evidence-based care, Anthem 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 for opioid addiction by 2019.
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 74 million people served by its affiliated companies, including more than 40 million within 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.
1 Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1