Health insurers and the companies they hire to manage pharmaceutical benefits are reporting early success in efforts to better manage access to opioid medications.
OptumRx, which is the pharmaceutical benefits manager at Minnetonka-based UnitedHealth Group, said this week that a pilot program has helped reduce inappropriate consumption of opioid painkillers at the heart of an addiction and overdose epidemic.
Indianapolis-based Anthem Inc., one of the nation's largest insurers, as well as pharmaceutical benefit manager Express Scripts, which is based in St. Louis, have reported results this summer that suggest insurance company programs can help control the supply of prescription opioids in beneficial ways.
Doctors have expressed some concerns about the trend nationally, warning that one-size-fits-all approaches might actually harm patients. But Dr. Beth Averbeck with Bloomington-based HealthPartners said insurers and health care providers can collaborate in beneficial ways to tackle the opioid crisis.
"We need to partner on this together, to be able to address it and come up with better alternatives for our patients and members," said Averbeck, who is the health system's senior medical director for primary care.
Opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects, according to the Centers for Disease Control and Prevention (CDC).
In 2013, health care providers wrote nearly a quarter of a billion opioid prescriptions, according to the CDC, with common types including oxycodone (OxyContin), hydrocodone (Vicodin), morphine and methadone. Studies suggest that as many as 1 in 4 patients receiving long-term opioid therapy in a primary care setting struggles with opioid addiction.
Nearly 2 million Americans either abused or were dependent on prescription opioid pain relievers in 2014, the CDC said, adding that taking too many prescription opioids can be deadly.
Anthem announced this week that its health plans reached a collective goal of reducing opioid prescriptions filled at pharmacies by 30 percent over a three-year period. Among other things, the company's health plans limited coverage for short-acting opioids to seven days for most patients.
Health insurers often institute such programs in conjunction with their pharmaceutical benefits manager, or PBM — a company that helps structure and manage medication benefits. Minnetonka-based Medica said it adopted new rules on opioid management earlier this year in conjunction with its PBM, which is Rhode Island-based CVS Caremark.
"Prescription drug overdose, abuse and dependence has a societal economic burden of more than $78.5 billion," CVS said in materials supplied by Medica.
OptumRx, which is the nation's third largest PBM behind Express Scripts and CVS, announced a program launched with more than 400 clients on July 1 that provides patient eduction and places maximum fill limits on opioid therapy. The company said it has already seen an 82 percent decrease in prescriptions above certain CDC guidelines for first-fill acute prescriptions.
Asked about the OptumRx program, Dr. Patrice A. Harris, immediate past chair of the board of trustees at the American Medical Association, said in a statement: "When patients seek physician help for an opioid use disorder — or need comprehensive care for chronic pain — one-size-fits-all limits, such as blanket prior authorization protocols, may cause delays in care that could severely harm patients."
Physicians are making strides to provide "more judicious prescribing decisions," Harris said, noting there has been a 17 percent nationwide decrease in opioid prescriptions since 2012.
"If opioids are not indicated, then we need payers and PBMs to work with physicians to ensure that patients have access to non-opioid and non-pharmacologic treatments," she said in the statement. "This is critically important as more patients now are dying from heroin and illicit fentanyl than from overdoses due to prescription opioids."
HealthPartners is both an insurance company and an operator of hospitals and clinics. Averbeck, the nonprofit's senior medical director, said the health insurance and health care delivery arms of HealthPartners have had success working together on the opioid problem.
As an insurance company, HealthPartners said it started putting checks in place in 2012. The health plan limits the number of pills covered, and refers to a program patients who receive multiple prescriptions from multiple health care providers.
The insurer said it has seen a 45 percent decrease in members with chronic high-dose opioid prescriptions, and a 22 percent decrease in members with one or more opioid prescriptions.
As a clinic operator, HealthPartners said late last year it reduced to 10 pills the automatic setting in its electronic medical record for opioid medications — half the previous setting. Many opioids over the years have been prescribed for patients with back pain, but HealthPartners said it has lowered the rate by promoting activity, exercise and physical therapy over medications.
"We've already seen decreased prescribing in a number of these areas," Averbeck said. "We want to make sure that we're partnering with patients and members to address their pain and help them in ways that are supportive, while at the same time decreasing the use of opioids."