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Anthem cuts opioid prescriptions by 30 percent, 2 years ahead of goal

Anthem-affiliated health plans are limited to seven days for the initial prescription for short-acting opioids.

Susan Morse, Associate Editor

Credit: <a href="https://upload.wikimedia.org/wikipedia/commons/0/09/Anthem-blue-cross.jpg">Eekster via Wikimedia Commons</a>Credit: Eekster via Wikimedia Commons

Anthem's health plans have reached the company's goal of reducing prescribed opioids filled at pharmacies by 30 percent.

The goal has been achieved two years earlier than projected for 2019.

[Also: OptumRx opioid risk management program to go nationwide]

During the past five years, the health plans began to limit short-acting opioid coverage to seven days for all individual, employer-sponsored and Medicaid members beginning new prescriptions. This policy does not apply to those who have cancer or sickle cell anemia or those who are receiving palliative care.

During the past year, health plans accelerated these policies.

Medicaid plans showed a 29 percent reduction in Virginia, 22 percent in Maryland, and a 9 percent reduction in Georgia.

[Also: Hospices struggle between opioid theft and supply chain access for dying patients]

Employer-sponsored and individual plans decreased opioid prescriptions by 23 percent in Nevada, 17 percent in Connecticut, and 17 percent in Wisconsin, according to Anthem. The quantity limits were consistent with Centers for Disease Control guidelines.

"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  Sherry Dubester, MD, Anthem vice president of behavioral health. "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."

[Also: Opioid overdose study from Beth Israel Deaconess researchers spotlights crushing burden on hospitals]

The short-acting opioid policy was rolled out in October 2016. Anthem-affiliated health plans are limited to seven days for the initial prescription for short-acting opioids. Members can only receive a maximum 14 days' supply for short-acting opioids in a 30-day period without additional authorization.

The prior authorization policy was put into place in September 2016. 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, and Medicare and Medicaid members, the insurer said. 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.

President Trump recently declared the opioid crisis a national emergency. From 2014 to 2015, drug overdose deaths increased by 5,349, or 11.4 percent, according to the Centers for Disease Control and Prevention.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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