Health Plans Join Prescription Painkiller Abuse Battle
Blue Cross Blue Shield of Massachusetts started ramping up efforts to help avert the misuse of painkillers about two and half years ago. "A small number of our members were responsible for a high number of our prescriptions," Tony Dodek MD, the Blue's associate chief medical officer and VP of medical quality and strategy, told me this week. "Those same numbers were driving up our costs."
The payer decided to help members find a balance between getting opioid pain medication when warranted, while avoiding the danger of addiction. A new painkiller prescription policy that applies to all members except cancer patients and the terminally ill has posted "remarkable results," he said.
Under that policy, health plan members trigger a painkiller safeguard program after they reach a 30-day treatment threshold. A threshold is described as any number of prescriptions in a coverage year that add up to 30 days of treatment with an opioid pain medication. Once a member reaches the 30-day threshold, the health plan requires pain management safeguards such as a treatment plan and limiting members to obtaining painkiller prescriptions from one physician.
Dodek says the new prescription policy has generated two positive results over its first 18 months:
- Prescriptions of narcotic pain medications fell by 6.6 million pills
- The company received only one member complaint.
"We had no disruption of pain medication for legitimate needs," he told me.
- Ebola: Health Officials Try to Quell Front Line Fears
- Reducing Readmissions Starts with Better Collaboration
- Ebola: A New Normal in Dallas
- Partners HealthCare M&A Deal Under Scrutiny
- Readmissions: No Quick Fix to Costly Hospital Challenge
- Health Literacy Month Gets a Boost from Payers
- 'Overtreatment' Debate Circles Back to Lung Cancer Screening
- Defensive Medicine Still Prevalent Despite Tort Reform
- Debate Over Consolidation's Effect On Cost Rages On
- How Top-Ranked MA Plans Earn Their Stars