Insurers restricting high-risk opioid users to select pharmacies
As the opioid epidemic continues to get worse, some health insurers are blocking patients identified as “high risk” from getting multiple opioid prescriptions filled at various pharmacies by restricting where they can fill prescriptions.
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More people died from drug overdoses in the U.S. in 2014 than during any previous year on record, according to the CDC, with nearly half a million people in the United States dying from drug overdoses between 2010-2014. Notably, at least half of all opioid overdose deaths involve a prescription opioid.
Early into Anthem’s Pharmacy Home Program to prevent opioid abuse and polypharmacy, the insurer has already identified high-risk patients and plans to start curbing opioid scripts filled by those patients. In May, Anthem began notifying members identified as “high risk” for opioid abuse that they would be enrolled in the program, which limits drug coverage to one member-chosen home pharmacy.
These patients can select the pharmacy of their choice. However, after that selection is made the insurer will only pay for opioid prescriptions dispensed by the selected pharmacy. “We have sent hundreds of letters out. It won’t be until July that we will have the first group of pharmacy members [in place],” said Lisa Morris, Anthem’s vice president of clinical and specialty pharmacy.
According to Anthem, it has found that 24% of members identified as “high risk” had filled 10 or more controlled substance prescriptions during a 90-day period. Plus, 13% filled controlled substance scripts at five or more pharmacies and 19% filled scripts from five or more prescribers during a 90-day period.
Morris is optimistic that Anthem’s program will produce similar results as its opioid abuse-deterrent program that was designed to identify high-risk members with the Medicaid program in Maryland. “We experienced an opioid-related spending decrease of 12%, driven by reductions in inpatient services, reduced emergency department [visits] and non-opioid prescription drug spending in our Medicaid program in Maryland,” Morris said.