Blue Cross and Blue Shield Companies Make Landmark Decision to Advance Better Treatment Options for Opioid Use Disorder

Study shows 29 percent decline in prescriptions filled

Chicago - Almost a quarter of a million Blue Cross and Blue Shield (BCBS) members were diagnosed with opioid use disorder in 2017. To find reliable support for these members – and all Americans suffering from opioid use disorder – BCBS companies will collaborate with experts and industry leaders to assess the effectiveness of treatment options and improve access to quality treatment services.   

According to a 2013 National Survey of Substance Abuse Treatment Services, only 22 percent of treatment centers were accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and only 19 percent were accredited by the Joint Commission. More than half of treatment programs are not accredited by either, highlighting a major gap in ensuring quality treatment.

Complementing local efforts to help members with opioid use disorder, the Blue Cross Blue Shield Association (BCBSA) Board of Directors at its June meeting agreed to advance nationally the safety and effectiveness of treatment for opioid use disorder. As part of that commitment, BCBSA will launch Blue Distinction® Centers for Substance Use Treatment and Recovery to ensure members have access to the best clinical thinking and evidenced-based approaches in dealing with the long-term issues associated with opioid use disorder. 

“BCBS companies are deeply committed to improving how we care for those currently suffering from opioid use disorder,” said Scott Serota, president and CEO of BCBSA. “Our goal is to assess the effectiveness of treatment options and close the gap in care to make a difference in not just our members’ lives, but the lives of all Americans.”

In addition, to provide resources for all Americans, the Board agreed to establish a national hotline to connect those in need with treatment centers. The hotline will be available to BCBS members and non-members.

Blue Distinction® Centers for Substance Use Treatment and Recovery and the national hotline will be operational by January 2020.

“We applaud BCBS companies for their leadership to advance quality opioid treatment. We worked with over 40 experts to develop a playbook that provides guidance on opioid stewardship and stand ready to partner with BCBS companies to help solve the nation’s pressing opioid problem.” said Shantanu Agrawal, MD, MPhil, president and CEO of the National Quality Forum. 
BCBSA also continues to analyze system-wide data through its Health of America Report series to inform the dialogue and solutions on the opioid epidemic. According to a five-year study of medical claims, the most recent report showed that opioid use disorder diagnoses declined slightly in 2017. In addition, the study shows a 29 percent decline in opioid prescriptions filled and a 25 percent decrease in the number of BCBS members who filled at least one opioid prescription in a year. Similarly, BCBS lowered opioid consumption by 26 percent for the Federal Employee Program in the same time period.

The report, “The Opioid Epidemic in America: An Update,” represents a comprehensive study of medical claims from BCBS commercially-insured members using opioid painkillers, as well as those diagnosed with opioid use disorder over a five-year period.*

The report finds that: 

  • Opioid use disorder diagnoses stabilized in 2016, with 6.2 in 1,000 BCBS members diagnosed. The rate declined to 5.9 in 2017, which was the first drop in the eight years BCBSA has measured diagnoses.**
  • There was a 29 percent drop in opioid prescriptions filled in 2017 compared to 2013. The number of BCBS members who filled at least one opioid prescription in a year decreased 25 percent, from 20 percent in 2013 to 15 percent in 2017.
  • Higher rates of opioid use disorder appear in New England and the South. New Hampshire has the highest diagnosis rate at 12.3 per 1,000 BCBS members, while South Dakota has the lowest rate at 2.2 per 1,000 BCBS members. 
  • Thirty-four states had a nearly 30 percent or greater reduction in opioid prescriptions filled, with Massachusetts leading with a 51 percent decline.

“We are encouraged by these findings, but we remain vigilant,” said Dr. Trent Haywood, senior vice president and chief medical officer for BCBSA. “More work is needed to better evaluate the effectiveness of treatment options and ensure access to care for those suffering from opioid use disorder. BCBS companies are committed to doing both.”

Blue Cross and Blue Shield companies have been addressing the opioid epidemic at the local community level by reducing opioid prescriptions, collaborating with medical professionals, employers and communities to address gaps in the continuum of care. These efforts are informing the national solutions.

In March, BCBSA’s National Council of Physician and Pharmacist Executives (NCPE) adopted a professional standard that opioids should not be prescribed as first or second lines of pain therapy in   most clinical situations. It is designed to limit unnecessary risk for the 106 million members served by BCBS companies. BCBS companies will promote alternatives that include more optimal use of non-opioid prescription painkillers and existing over-the-counter pain medications.

The BCBS Health Index℠ identifies substance use disorder as the sixth most impactful condition affecting the health of commercially-insured members in the U.S. For more information about BCBS companies’ local efforts to combat opioid misuse, visit

This is the 21st study of the Blue Cross Blue Shield: The Health of America Report® series, a collaboration between BCBSA and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into healthcare affordability and access to care. For more information, visit
*Members diagnosed with cancer or who were undergoing palliative or hospice care were excluded from this analysis.

** BCBSA published a report in 2017 titled “America's opioid epidemic and its effect on the nation's commercially-insured population,” which looked at opioid use from 2010 through 2015. 

About Blue Health Intelligence
Blue Health Intelligence (BHI) is the nation’s premier resource for data-driven insights about healthcare trends and best practices, promoting healthier lives and more affordable access to safe and effective care. BHI leverages a team of analytics experts and advanced technology, coupled with access to the greatest number of healthcare claims—172 million lives—gathered over 10 years in a safe, HIPAA-compliant, secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Blue Health Intelligence (BHI) is an Independent Licensee of the Blue Cross Blue Shield Association. BHI is a trade name of Health Intelligence Company, LLC.

About Blue Distinction Centers 
Blue Distinction Centers (BDC) met overall quality measures, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable healthcare. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.

The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies.