Blue Cross Blue Shield of Massachusetts is implementing what it says are industry-leading policies to restrain the abuse of opioid medications among its members, including a requirement that new opioid drug prescriptions written for quantities of longer than 30 days must be accompanied by a medical authorization before coverage is approved. The new policies become effective July 1.
BCBS Massachusetts said in a statement that it developed the new policies after an internal review showed that 30,000 of its members received prescriptions for short-acting pain killers lasting longer than 30 days, "a practice that many experts believe increases the chances of drug misuse, dependency, and diversion."
Massachusetts has seen a significant increase in opioid-related deaths and hospital stays over the past decade mainly due to heroin use, but in part because of the increased availability, misuse, and abuse of prescription pain killers, according to the health plan.
The new policies also mandate that all prescriptions for a short-acting opioid be obtained from just one prescriber or prescribing group and that scripts must be filled at one designated pharmacy or pharmacy chain. The restrictions appear to go further than those set by other private insurers, which first determine if a potential problem exists through claim reviews before restricting members’ access to opioid coverage.
The health plan also will require written agreements between the prescriber and the patient that address prescription management, diversion, the use of other substances while taking pain medication, and informed consent regarding the risks involved in taking prescription pain killers. Physicians and other prescribers also will be required to make a formal assessment of addiction risk and to develop treatment plans that include a "clear diagnosis, explicit goals and exploration of other treatment options for pain."
For long-acting opioids, the plan said it will apply new guidelines in approving initial prescriptions. Special accommodations, however, will be made for patients on chronic medications, those with cancer, and those who are at the end of life.
In curtailing member access to opioids, the actions by BCBS Massachusetts are in line with 2011 recommendations from the Government Accountability Office aimed at the Medicare Part D program. The GAO report also noted the growing incidence of doctor shopping, in which beneficiaries were obtaining more drugs than were medically necessary and urged Medicare to limit patients to a single physician and single pharmacy.
When called to testify before a Senate panel regarding the GAO report, officials from the Centers for Medicare and Medicaid Services cautioned that the GAO recommendations also might prevent appropriate medical use. They suggested better use of existing programs such as drug utilization review might address the situation – and pointed out that current Medicare statutes bar the kind of limitations suggested by the GAO.
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