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Opioid Management

Opioid Management Strategy

Despite our existing strategies promoting appropriate opioid use, Alabama ranked first in the nation in number of opioid prescriptions per capita in 2015. The recent Blue Cross and Blue Shield Association’s “Health of America Report” on the opioid epidemic showed over 26 percent of its commercial members in Alabama filled at least one opioid prescription in 2015, and 16 out of every 1,000 members were diagnosed with opioid use disorder. The CDC reports that between the years 2000 and 2015, more than half a million people across the U.S. died from drug overdoses, and 91 Americans die each day from an opioid overdose.

In an effort to help battle the growing opioid epidemic in Alabama, we have launched an opioid management strategy. This strategy was created with guidance from the CDC’s “Guidelines for Prescribing Opioid for Chronic Pain” publication. Members with cancer and those who are currently receiving opioids will not be subject to the guidelines below that are designed to decrease misuse of opioid prescriptions.

Guidelines

  • Members are limited to a seven-day supply the first time they fill a short-acting opioid medication. If an initial fill for a supply of more than seven days is needed, a member’s doctor can submit a one-time prior authorization for an initial fill of a supply greater than seven days. Short-acting opioid medications include Lortab, Vicodin, Percocet, etc.
  • Members are required to obtain a prior authorization for all first-time prescriptions for long-acting opioid medications, including OxyContin and MS Contin.
  • Naloxone, the antidote for an opioid overdose, is available to most members for the generic copayment.

Note: This includes both the prefilled syringes and nasal spray. Evzio, an auto-injector antidote, is no longer covered. The manufacturer of Evzio has repeatedly increased its prices. In 2014, the price was $690 and increased to $4,500 in 2017. The price of the nasal spray and prefilled syringes is approximately $80 and $150 per prescription, respectively. This makes Evzio now 30 – 56 times the cost of alternative naloxone formulations.

For more information on these guidelines, see our new pharmacy policies, “Opioids ER Prior Authorization and Quantity Limit Criteria Program Summary” and “Opioid Immediate Release Duration Limit and Quantity Limit Program Summary.”

Pain Medication and Care Improvement Program

We have partnered with axialHealthcare®, a national leader in pain management and pain medication solutions, to provide a Pain Medication and Care Improvement Program. Together, we are collaborating with Alabama physicians to help curb the epidemic of opioid misuse. This partnership supports providers by:

  • Giving a more comprehensive view of a patient’s medical history.
  • Providing ongoing consultation with axialHealthcare’s team of licensed pharmacists.
  • Increasing awareness of prescribing behaviors and the latest evidence-based guidelines.
  • Sharing resources and educational tools to support appropriate prescribing protocols.

Opioid Pain Management Tool

The Opioid Pain Management Tool provides advanced analytics regarding your prescribing patterns and your patients’ opioid prescription history. The data is based exclusively on Blue Cross and Blue Shield of Alabama claims data for most, but not all, Blue Cross members. Data in the tool will be updated monthly.

You can access the tool by selecting “Opioid Pain Management Tool” from the ProviderAccess Profiles & Reports menu. View our Opioid Pain Management Tool Overview flier for more information.

The Opioid Reduction Tool is available to help providers reduce or remove opioid use for their patients. Review this guide for using the Opioid Reduction Tool, which is part of the Opioid Pain Management Tool.

Clinical Pharmacy Specialists from axialHealthcare will contact Alabama providers to offer pain management/medication consultative services to help reduce opioid misuse. We appreciate your support as we tackle this important health and safety issue for our members. Blue Cross will eventually determine qualification for incentive programs based on the Opioid Pain Management Tool Risk Identification Mitigation (RIM) score rather than the opioid prescribing rate.

 

An independent company, axialHealthcare provides pain care analytics and evidence-based solutions for physicians in the Blue Cross and Blue Shield of Alabama network