Combating The Opioid Crisis: How Innovative Programs And Partnerships Can Help

by Dr. Sherry Dubester, Anthem, Inc.

September 20, 2017

The United States’ opioid crisis has reached a critical point. This epidemic has been devastating to communities across our country, and has, in turn, demanded a swift and impactful response.

One major factor contributing to this crisis is that opioid prescribing practices have not been subject to a high level of scrutiny for more than a decade. There has been insufficient training with respect to prescribing guidelines and a lack of regulation regarding responsible prescribing practices. When it comes to the treatment of opioid addiction, there has been a lack of adequate access to high-quality, evidence-based treatment, including medication-assisted treatment (MAT).

Anthem’s Efforts

It is our responsibility as a health plan to do what we can to address this health epidemic, and Anthem remains committed to making a significant difference in the lives of our members and their families. As part of this commitment, Anthem reached the company’s collective goal of reducing prescribed opioids filled at pharmacies by 30 percent during the past five years – two years earlier than the expected 2019 goal.

Anthem is working on a number of initiatives to address the opioid crisis. Leveraging our analytics capabilities to identify specific areas of opportunity, we are working with stakeholders across our company, as well as medical and behavioral health providers caring for our members, and the broader markets we serve to promote prescription opioid management best practices, support early identification and evidence-based treatment of opioid use disorder, and enhance our understanding of and approach to non-pharmacologic pain management.

Anthem is aligning its pharmacy approval criteria with opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC) to help prevent accidental opiate addiction, ensure clinically appropriate use, and provide access to rescue medications in an effort to reduce risks of accidental overdose. Additionally, Anthem alerts prescribers about patients with controlled substance usage patterns that suggest high risk and is expanding these alerts in alignment with the CDC guidelines.

An important program in place for both our commercial and Medicaid membership is our Pharmacy Home Program, which works to help improve drug safety and care quality. The program is designed to identify a small set of high-risk members who are obtaining multiple prescriptions filled at multiple pharmacies by multiple prescribers who may be unaware that this dynamic is unfolding. By leveraging a single pharmacy selected by the member, the program more actively coordinates that member’s controlled substance medication. In some of our Medicaid plans, we also have a Prescriber Home component that oversees the prescribers for controlled substances.

Additionally, we are launching market-based initiatives to ensure expanded access to high-quality Substance Use Disorder treatment. This includes efforts to expand our provider networks’ MAT prescribing capabilities, particularly in underserved, rural areas. We are also collaborating with providers like Aware Recovery in Connecticut and New Hampshire to deliver evidence-based opioid addiction treatment via an innovative in-home care delivery model as well as pending telehealth service delivery through another provider.

Our Medicaid division is working with several states to incentivize providers to take on more MAT patients and expand Drug Enforcement Administration (DEA) waivers to prescribe or dispense buprenorphine for opioid dependency treatment.

Learnings for the Future

Through implementing these various efforts, Anthem has gained knowledge of drug abuse prevention and treatment that is leading to new programs and partnerships. For example, Anthem is further leveraging its analytics capabilities to develop methods to identify members who are high-risk opioid users and to support initial treatment planning for pain management. Additionally, we are collaborating with providers to deliver evidence-based opioid addiction treatment via additional channels such as telehealth.

Much still needs to be done to reduce prescription opioid abuse and addiction, and we will continue to look for opportunities – advocacy, provider collaboration, and other avenues – to appropriately reduce prescription opioids, support broader pain management strategies, improve access to evidence-based treatment for addiction, and decrease overdose deaths.

Sherry Dubester, MD, MS, is Vice President of Behavioral Health and Clinical Programs at Anthem, Inc.