Independence Blue Cross reports dramatic drop in opioid prescriptions among members

Members of Blue Cross Blue Shield are prescribed fewer opioids at lower doses, the insurance giant said in a report released Thursday. Officials said they "are making progress" in a crisis that killed tens of thousands in 2016.

In the Philadelphia area – which includes parts of Pennsylvania, Maryland, New Jersey and Delaware, and where Independence Blue Cross is the largest private insurer – opioid prescriptions among BCBS members have dropped by 32% between 2013 and 2017.

This is more than the national average, which has seen these orders fall by 29% in the same period.

But nearly 242,000 members were diagnosed with opioid use disorder in 2017 alone – with 7.9 diagnoses per 1,000 members in the Philadelphia area, the company said:

" We have seen an increase in the use of drug treatment in 2017, and then it has capped, "said Virginia Calega, vice president of management and medical policy for the Blue Cross. independence.

Although prescription pain medications were widely reported to initiate the overdose crisis, last year. The official in charge of disease control and prevention told a congressional committee that heroin and illicit fentanyl, a synthetic opioid much more potent than heroin, are now fueling the continuing rise in deaths by overdose.

Calega said the increase in the number of patients on drug treatment, considered the gold standard for lasting cure, may be limited by federal restrictions on salvage drugs such as suboxone which is itself an opioid. Used as directed, it prevents cravings and withdrawal pains that often condemn recovery efforts, but it does not create euphoric effects. Independence no longer requires pharmacies to obtain prior authorization before delivering the drug. But doctors are still required to undergo training and obtain a waiver from the Drug Enforcement Administration before they can prescribe suboxone – which means that it can be harder to prescribe a treatment than to prescribe a narcotic . The waiver obligation limits the number of doctors available to treat patients.

Providers, said Calega, have started talking about "it's time to start trying to get more providers trained to administer suboxone therapy." Many other insurers, medical practices and public health agencies, including the Philadelphia Health Department, have worked to limit the prescription of opioids. Last year, said Calega, independence has begun to restrict opioid prescriptions to a five-day supply for new users at low doses. (Patients with cancer and terminal illnesses are exempt.) Calega said the policy change is leading to decreases in the prescription and use of opioids. Members using opioids have dropped 22% in the last six months of 2017 and the number of opioid prescriptions has dropped by 26% over the same period in 2016.

The Company also contacted about 1000 independence physicians whose patients were taking more than opioid doses recommended by the CDC; 60% "changed or decreased their prescribing habits" over a six-month period.

"We are really trying to educate providers about alternatives to opioids – and be careful about the number of days you prescribe them," Calega says. "We had seen problems where people went for the removal of wisdom teeth, and get a 30-day prescription for a narcotic."

At the same time, some patients and advocates of chronic pain have said attempts to curb prescription are hurting people who need medication to function. The other major insurer in the region, Aetna, asks patients with chronic pain to obtain prior authorization each year for opioid doses above a certain level. (Blue Cross Independence also requires prior approvals, but not at a particular dose.) Calega said that the company's prescribing practices are primarily focused on opioid users for the first time: "We Let's try to prevent anyone from starting this journey. "