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Protecting Patients From Opioid Abuse

posted by Darcy Lewis

on September 18, 2017

In August, U.S. President Donald Trump declared the opioid epidemic a national emergency and said his administration was drafting papers to make it official. It was just another sign of this deepening crisis, which health plans have been tackling head-on with carefully targeted strategies and policies, in many cases going back years.

Increasingly, many health plans are refining their approaches and driving the innovations needed to protect patients and curtail the misuse of prescription opioids.

Here’s a look at what two Pennsylvania health plans are doing to limit inappropriate opioid use.

Independence Blue Cross/IBC Foundation

In Philadelphia, Independence Blue Cross developed a number of initiatives to prevent and fight opioid addiction, such as restricting initial prescriptions of low-dose opioids to five days or less, with exceptions for patients like those with cancer or in hospice care. The plan does permit exceptions for prescriptions related to cancer pain and hospice care.

Since 2014, Independence has worked with its network physicians to control opioid prescribing. The plan regularly promotes Centers for Disease Control (CDC) prescribing guidelines with its providers and notifies those who fall outside the guidelines.

Results from early 2017 indicate that Independence is heading in the right direction: The number of members taking opioids has dropped by nearly 30 percent. At the same time, the number of opioid prescriptions has fallen by more than one third.

And in August, Independence began covering methadone treatment with no copays to give members more access to treatment for opioid addiction .

These policies are in addition to the Independence Blue Cross Foundation’s Supporting Treatment and Overdose Prevention (STOP) Initiative. STOP provides financial support to community nonprofits that offer medication-assisted treatment and Centers of Excellence that bridge gaps in care coordination.

The initiative also works to raise awareness of drug takeback locations and trains nurses in best practices for identifying and caring for patients with opioid addiction. STOP  research funding helped develop a warm-handoff model for overdose survivors that goes beyond just giving patients a referral and directly connects them to the treatment they want and need — a model that can be replicated in emergency rooms across the region and nation.

UPMC Health Plan

The University of Pittsburgh Medical Center (UPMC) Health Plan, which serves three million members, is combatting the opioid epidemic by integrating behavioral health and primary care.

UPMC Health Plan offers Special Program Assistance for Providers via a single phone number or email address. Services include:

  • Health management coaching
  • Behavioral health case management
  • Referral coordination
  • Warm transfer to a psychiatrist

Additionally, physical health providers can “prescribe” substance use care management programs to encourage members to “cross over” to the behavioral health side. The health plan also offers psychiatry consultations for primary care and specialists that include “warm transfers” to a psychiatrist to provide consultation to physical health providers regarding substance use issues.

UPMC Health Plan also covers treatment with buprenorphine, a crucial component of treating addiction and substance abuse.

It also continues to co-sponsor the Pregnancy Recovery Center at Magee-Women’s Hospital of UPMC, the first and only program in the region to provide both prenatal care and substance abuse treatment. At the Pregnancy Recovery Center, pregnant women and new moms can receive office-based buprenorphine treatment, behavioral health counseling, and medical and social services support.

The UPMC Center for High-Value Health Care oversees a grant from the Pennsylvania Department of Drug and Alcohol Programs to expand, enhance, and evaluate access to the use of medications in combination with counseling and behavioral therapies, also known as medication-assisted treatment (MAT).

The important efforts of these health plans show that diverse approaches are necessary to make a real difference in the opioid crisis.


This article is the first of a continuing series that will focus on the many ways health plans are working to combat the opioid epidemic.