Empire BlueCross and BlueShield helps to reduce opioid use in New York by 13 percent among its members

Business Wire

NEW YORK--(BUSINESS WIRE)-- Prescribed opioids for members of Empire BlueCross and BlueShield have dropped by 13 percent for individual and employer-sponsored members in the past year.

Limiting coverage of opioids to seven days to those newly starting opioids, requiring provider prior authorization and directing those most at risk for opioid use disorder to one pharmacy have all been a factor in reducing opioid prescriptions. The primary goal of the quantity limits was to prevent inadvertent addiction and opioid use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control guidelines.

Empire and its affiliate plans contributed significantly to its parent company meeting a national goal to reduce opioids filled at the pharmacy by 30 percent since the opioid prescription peak in 2012.

“As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” said Larry Schreiber, president, Empire BlueCross and BlueShield. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

The opioid crisis was declared a national emergency by President Trump earlier this month. Drug overdose is the leading cause of accidental death in the U.S. exceeding car crashes and guns.¹ From 2014 to 2015, drug overdose deaths increased by 5,349 or 11.4 percent, signifying a continuing trend observed since 1999, according to the Centers for Disease Control and Prevention.

“We’re hoping our policies can help prevent members from developing opioid use disorder by carefully limiting coverage on quantities for short-acting opioids and requiring prior authorization from their prescriber to ensure a clinical need for long-acting opioids,” said Schreiber. “We continue to explore additional ways to help ensure clinically appropriate use of opioids, and help prevent inadvertent addiction and opioid use disorder.”

Empire took the following steps designed to help ensure clinically appropriate use of opioids and to proactively prevent the development of opioid use disorder:

For short-acting opioids, initial prescriptions are limited to seven days. Members can only receive a maximum 14 days’ supply for short-acting opioids in a 30-day period without additional authorization, consistent with CDC Guidelines. The quantity limits began rolling out in October, 2016, for individual short-acting opioids, with the limit on the most popular drug, hydrocodone-acetaminophen, taking effect in July.
For all long-acting opioids, prior authorization was put into place in September, 2016, for initiation of therapy. Quantity limits for long-acting opioids have existed for many years, with exceptions for those have terminal or chronic illness.
Pharmacy Home programs exist for individual, employer-sponsored, and Medicare members that can assign members to one pharmacy and/or one provider for their opioid prescriptions. The program allows doctors to better monitor access of opioids and helps ensure members are receiving counseling and mental health support.
Providers who receive member electronic dashboards are notified when a member is at greater risk for developing opioid use disorder – such as prescriptions from several providers or pharmacies, or when the member has prescriptions for opioids, muscle relaxants and benzodiazepines at the same time.
Providers are alerted of additional controlled substance use concerns and associated emergency room or urgent care use through letter, including when the member has prescriptions for both Suboxone and opioids or on persistent high doses of opioids.

The pharmacy policy changes are part of Empire’s holistic approach to prevention, deterrence and treatment to reduce the impact of this epidemic. To help ensure members have access to comprehensive evidence-based care, Empire also is committed to helping its affiliated health plans double the number of members who receive behavioral health services as part of medication-assisted therapy, drug and talk therapy, for opioid use disorder by 2019.

About Empire BlueCross BlueShield

Serving New Yorkers for 80 years, Empire BlueCross BlueShield is the largest health insurer in New York supporting more than four million members and more than 38,000 business, union and small employers in New York. Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at www.empireblue.com. Also, follow us on Twitter at @empirebcbs.

¹ Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1