Health Plans Provide Leadership To Address The Opioid Crisis

by Kate Berry

July 26, 2016

The number of opioid prescriptions has nearly doubled since the late 1990s and now exceeds 200 million. In parallel, there’s been a dramatic increase in prescription drug overdoses – more than 47,000 drug overdose deaths in 2014 alone. Concerns about growth in opioid misuse, addiction, and overdoses have led health plans to take a leadership role in combating this public health crisis.

Here are a few examples.

Harvard Pilgrim Health Care

Encouraging non-opioid approaches to managing pain when appropriate. For example, Harvard Pilgrim Health Care covers pain treatments such as non-opioid prescription drugs, physical therapy (PT) or occupational therapy, massage therapy as part of a PT regimen, chiropractic care, acupuncture, and other medical interventions.

Blue Cross Blue Shield of Massachusetts

Using medication management tools to avoid unnecessary increases in dosages, reduce long-term use, and mitigate the risk of addiction. Blue Cross Blue Shield of Massachusetts implemented an Opioid Safety Management Program requiring prior approval to refill short-acting opioid prescriptions and for new prescriptions for long-acting opioids. In three years, this program reduced opioid prescriptions by an estimated 21 million while ensuring accessible and appropriate care for treating patients in pain.


Analyzing pharmacy claims information to understand prescribing patterns and provide a range of reports to help physicians identify and proactively engage individuals who may be at risk for opioid misuse. As part of a broad set of strategies to encourage safe opioid prescribing and non-pharmacologic pain management and improve evidence-based treatment of substance use disorders, Anthem launched a Pharmacy Home Program focusing on a small but extremely high-risk segment of consumers in 14 states who choose a single pharmacy to fill their prescriptions.


Identifying substance use disorders as a chronic condition and coordinating evidence-based care such as medication assisted treatment (MAT) along with behavioral counseling and support services. Cigna is working with its network to expand access to MAT as part of a comprehensive treatment program. Cigna also committed to reduce opioid use among its customers by 25 percent within three years.

Stakeholder Efforts

Health plans’ initiatives support the work of many stakeholders across the health system to address opioid abuse and addiction. The U.S. Department of Health and Human Services (HHS) published a strategy on interventions to improve pain care. The Centers for Disease Control and Prevention (CDC) released opioid prescribing guidelines for primary care physicians. The National Governors Association (NGA) released a Road Map for States and signed a compact to fight addiction. The American Medical Association (AMA) created a repository of educational resources for physicians.

Continued Progress Needed

Combating opioid overuse and addiction requires a comprehensive approach that includes evidence-based treatments for pain management, more cautious opioid prescribing, careful patient monitoring, and access to substance use disorder treatment when needed. But more still needs to be done. Here is what we recommend:

  • Develop best practices and validated, well-defined criteria for establishing “centers of excellence” in pain management and substance use disorder treatment.
  • Provide ongoing education for providers and consumers about approaches to managing pain and the benefits and risks of opioids.
  • Improve the accuracy, timeliness, ease of use and access, and cross-state sharing of information collected from Prescription Drug Monitoring Programs – state databases tracking controlled substances including opioid prescriptions.
  • Expand the capacity for treating opioid addiction – strengthening the workforce of providers to manage MAT and deliver behavioral counseling, as well as increasing availability of community-based support resources to assist with recovery.
  • Enhance communication and coordination of services between primary care providers, specialists, and mental health practitioners to improve care.

Kate Berry is Senior Vice President of Clinical Affairs and Strategic Partnerships at AHIP.