Using prevention, treatment and data to tackle the opioid epidemic

On average, 115 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC). As a healthcare partner to one in three Americans, Blue Cross and Blue Shield (BCBS) companies are committed to working in every community to fight our nation’s opioid epidemic. We’ve already taken significant steps to prevent addiction, improve access to treatment and help patients get on the path to recovery, while harnessing data insights to inform policymakers and government leaders. And we’re not letting up .

Boosting prevention efforts to curb the opioid epidemic

Prevention is the first line of defense against opioid addiction and involves promoting appropriate opioid prescribing; fighting prescription abuse and fraud; and increasing awareness of the dangers of opioids.

In order to reduce opioid overprescribing, we are encouraging the use of non-opioid medications and other therapies as appropriate. The BCBS National Council of Physician and Pharmacist Executives (NCPE) adopted a new professional standard that says opioids should not be prescribed as a first or second line of pain therapy in certain clinical situations. This new standard aligns with the CDC Guideline for Prescribing Opioids for Chronic Pain, which BCBS companies have endorsed.

BCBS companies are partnering with doctors and hospitals to reduce avoidable opioid prescriptions. Anthem Blue Cross and Blue Shield has cut the number of opioids filled at pharmacies by 30 percent. Prescribed opioids for members of Anthem Blue Cross and Blue Shield of Ohio dropped by 16 percent in 2017, thanks in part to policy changes. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members,” said Steve Martenet, president of Anthem Blue Cross and Blue Shield of Ohio.

Disposing of unused opioids also helps curb the misuse of these medications. BCBSA’s partnership with Walgreens aims to place drug takeback boxes in 1,500 Walgreens stores across the country for safe disposal of unused opioids and other medications. BCBS companies are boosting these efforts in their own markets, such as Blue Cross and Blue Shield of Louisiana (BCBSLA)’s goal to place takeback boxes in every parish in the state.

We’re working with government and law enforcement officials, as well as healthcare providers, to prevent, identify and stop prescription fraud and abuse. Many BCBS companies use special investigation units to uncover and address fraud and abuse involving opioids. These units also oversee programs that identify at-risk members who are filling prescriptions at multiple pharmacies or doctors’ offices, commonly referred to as doctor or pharmacy “shopping.”

Many BCBS companies review claims data regularly to spot any unusual opioid prescribing patterns and reach out to doctors to alert them—identifying ways to improve their adherence to appropriate prescribing guidelines. BCBSLA’s senior medical director Deirdre Barfield, M.D., says “We want the providers to do the right things for members, and we want to make that easy.” So BCBSLA developed a toolkit for doctors who write the most opioid prescriptions. It contains guidelines for safe prescribing and a copy of a contract to sign with patients regarding safe opioid use. “It also gives them a checklist for opioid addiction screening and includes information on available behavioral health resources,” said Barfield.

Aiding the path to recovery through the right treatment options

Without treatment, the disease of addiction is chronic, progressive, and sometimes fatal. Evidence-based, patient-focused treatment helps patients with opioid use disorder begin and maintain their recovery from addiction.

While some patients may seek treatment on their own, others may respond to an offer to help. BCBS companies are exploring new ways to make these connections and improve access to treatment. Horizon Blue Cross and Blue Shield of New Jersey (Horizon) is closely following up with patients who experience an opioid overdose. In a Newark hospital emergency department, Horizon has placed recovery specialists who can begin a conversation about recovery and connect patients with treatment before they are discharged. Horizon’s Clinical Design Liaison Tracy Parris-Benjamin says partnering with the hospital makes sense because “it’s in an area where there is obviously an opportunity to engage members but also address the wider opioid epidemic.”

Some areas of the country face a shortage of doctors who are trained to treat opioid use disorder. Several BCBS companies are helping to close those gaps in training and access to doctors and hospitals. Excellus BlueCross BlueShield has been a key partner in the region’s Project ECHO program, which connects physicians with addiction specialists via weekly tele-consults for general and case-specific training.

The growing opioid crisis requires health plans to adapt coverage and reimbursement policies to meet new needs. Many BCBS companies have modified their benefits to reduce barriers to care. For example, several Plans have removed prior authorization requirements for Medication Assisted Treatment, making it easier for members to begin their recovery as quickly as possible.

Leveraging data insights and supporting research to shed light on the opioid crisis

Leveraging insights from the data we derive from covering one in three Americans can help all of us gain a better understanding of the scope of the opioid crisis and support researchers and policymakers in their search for solutions.

By using advanced analytics to interpret healthcare claims data from more than 140 million individuals nationwide, we are able to uncover key healthcare trends. The Health of America Report, “America’s opioid epidemic and its effect on the nation’s commercially insured population,” shows the relationship between opioid use disorder and opioid prescription dose and duration.

Through a partnership with the Brain Research Foundation, BCBSA is funding research, with an emphasis on reducing relapse rates, in hopes that it will lead to new and more effective ways to treat substance use disorder. Through the Alliance for Health Research, we are supporting research at Harvard Medical School to better understand opioid prescribing patterns.

We recognize solving the opioid crisis requires persistence, innovation and compassion. It requires many approaches and many partners. We’re committed to these efforts as we are committed to the health and well-being of our more than 106 million members nationwide.

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