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Health Plans Join Prescription Painkiller Abuse Battle

Christopher Cheney, for HealthLeaders Media, May 7, 2014

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:

  1. Prescriptions of narcotic pain medications fell by 6.6 million pills
  2.  The company received only one member complaint.

"We had no disruption of pain medication for legitimate needs," he told me.

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