Capital BlueCross Announces Significant Reduction in Opioids Dispensed Following Prescription Limitations

HARRISBURG, Pa. -- Capital BlueCross today announced that quantity limits enacted in July 2017 are showing promising results in combatting the opioid epidemic. Between the second and third quarter of 2017, the amount of opioid tablets dispensed to Capital BlueCross members decreased by 42-percent. The total amount of members using opioids was also reduced by 12-percent. We were able to accomplish this due to our close working relationships with our provider partners.

Since putting quantity restrictions in place, Capital BlueCross only allows coverage for a one-week supply (7-days) on all short-acting opioids such as hydrocodone/ acetaminophen and oxycodone IR. Prior authorization and quantity limits are also in place for long-acting opioids.

The quantity limitations are based on the particular drug being prescribed and the dosage strength. The limitations are aligned with Centers for Disease Control (CDC) recommendations for acute and chronic pain.

Capital BlueCross works with physicians, government agencies, and our communities to ensure opioids are prescribed in accordance with medical research, direction from the CDC, and in the best interest of our members' health.

"Since the limitations were put into place, we have also seen a decrease in the dosage strength prescribed to our members. This is promising, because the higher the dosage of an opioid, the more likely someone is to have an adverse outcome, including the potential development of substance use disorder and addiction," said Dr. Jennifer Chambers, Capital BlueCross, Chief Medical Officer. "We take our role in fighting this epidemic very seriously. Eighty percent of first time heroin users previously used/misused prescription opioids. That is why it is critical that we do our part to stem the flow of prescription opioids in our communities."

Other steps taken by Capital BlueCross to battle the opioid epidemic include:

  • Advocating for non-opioid pharmacological therapies first and enhanced coverages for non-pharmacological treatments for pain such as acupuncture, bio-feedback, and chiropractic care.
  • Continuously working to improve clinical management of opioid use and how we help our members manage pain.
  • Actively supporting drug take-back initiatives, including the ability to safely discard unused medications at our Capital Blue health and wellness centers.
  • Expanding the use of the safety and monitoring program from CVS Health, which enables pharmacists to identify and report suspected opioid misuse to a member's doctor and other prescribers, including alerts to prescribers and dispensers of opioids when members receive an opioid prescription from more than one prescriber, or for more than one drug class, such as the addition of benzodiazepines like Xanax.
  • Providing medication assisted treatment, which covers medication prescribed to help individuals overcome addiction, as a covered benefit for our members.
  • Partnering with experts to provide programs offering personalized support to our members dealing with chronic pain; these programs are targeted to help alleviate symptoms and improve quality of life.

Capital BlueCross has also contributed $200,000 to law enforcement officers in our service area since 2014 to purchase naloxone. This life-saving medication can revive a person who is suffering a potentially fatal overdose.

About Capital BlueCross
Capital BlueCross, headquartered in Harrisburg, Pa., is the leading health solutions and insurance company in Central Pennsylvania and the Lehigh Valley. A partner in the community's health for 80 years, Capital BlueCross offers health insurance products, services and technology solutions that provide peace of mind to consumers and promote health and wellness for our customers.

More than a health insurer, the company delivers innovative solutions through a family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies. Additionally, Capital BlueCross is growing a network of Capital Blue stores that provide in-person service and inspiration to help people reach their health goals. Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. For more information, visit

About Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit We also encourage you to connect with us on Facebook, check out our videos on YouTube and follow us on Twitter.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.