Blue Cross and Blue Shield of Georgia Helps to Reduce Opioid Use in Georgia by 10 Percent among Its Members

ATLANTA--(BUSINESS WIRE)--Prescribed opioids for members of Blue Cross and Blue Shield of Georgia (BCBSGa) have dropped by 10 percent in the past year.

Limiting coverage of opioids to seven days to those newly starting opioids, requiring provider prior authorization and directing those most at risk for opioid use disorder to one pharmacy have all been a factor in reducing opioid prescriptions. The primary goal of the quantity limits was to prevent inadvertent addiction and opioid use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines.

BCBSGa and affiliate plans contributed significantly to its parent company meeting a national goal to reduce opioids filled at the pharmacy by 30 percent since the opioid prescription peak in 2012.

“As a health insurer, we have a responsibility to acknowledge this health epidemic and do what we can to address it. We are pleased to see our effort is making a significant difference,” said Jeff Fusile, President of BCBSGa. “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.”

The opioid crisis was declared a national emergency by President Trump earlier this month. Drug overdose is the leading cause of accidental death in the U.S. exceeding car crashes and guns. ¹ From 2014 to 2015, drug overdose deaths increased by 5,349 or 11.4 percent, signifying a continuing trend observed since 1999, according to the Centers for Disease Control and Prevention.

“We’re hoping our policies can help prevent members from developing opioid use disorder by carefully limiting coverage on quantities for short-acting opioids and requiring prior authorization from their prescriber to ensure a clinical need for long-acting opioids,” said Anthony Sabatino, MD, Chief Medical Officer of BCBSGa. “We continue to explore additional ways to help ensure clinically appropriate use of opioids, and help prevent inadvertent addiction and opioid use disorder.”

BCBSGa took the following steps designed to help ensure clinically appropriate use of opioids and to proactively prevent the development of opioid use disorder:

• For short-acting opioids, initial prescriptions are limited to seven days. Members can only receive a maximum 14 days’ supply for short-acting opioids in a 30-day period without additional authorization, consistent with CDC Guidelines. The quantity limits began rolling out in October, 2016, for individual short-acting opioids, with the limit on the most popular drug, hydrocodone-acetaminophen, taking effect in July.
• For all long-acting opioids, prior authorization was put into place in September, 2016, for initiation of therapy. Quantity limits for long-acting opioids have existed for many years, with exceptions for those have terminal or chronic illness.
• Pharmacy Home programs exist for individual, employer-sponsored, Medicare and Medicaid members that can assign members to one pharmacy and/or one provider for their opioid prescriptions. The program allows doctors to better monitor access of opioids and helps ensure members are receiving counseling and mental health support.
• 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.
• Providers are alerted of additional controlled substance use concerns and associated emergency room or urgent care use through letter, including when the member has prescriptions for both Suboxone and opioids or on persistent high doses of opioids.

The pharmacy policy changes are part of BCBSGa’s holistic approach to prevention, deterrence and treatment to reduce the impact of this epidemic. To help ensure members have access to comprehensive evidence-based care, BCBSGa also is committed to helping its affiliated health plans double the number of members who receive behavioral health services as part of medication-assisted therapy, drug and talk therapy, for opioid use disorder by 2019.

¹ Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1