Insurers Spending Less On Opioids

The number of opioid prescription reimbursements fell dramatically in one of the largest health insurance networks in the region in late 2016, suggesting efforts to cut widespread abuse might be working.

The decline, reported by Highmark in September, October and November, coincided with the launch of the state's new prescription-drug monitoring program, which lets doctors see if a patient has gotten prescription painkillers or other potentially addictive drugs from other physicians.

From January through August, Highmark said, the number of reimbursements each month ranged from 118,261 to 110,045. From September through November, they ranged from 107,477 to 107,843. December numbers are not yet available.

Other insurers also have reported change in opioid prescriptions, with Capital BlueCross saying it has seen "a small but continued decrease," and UPMC Health Plan telling the Pittsburgh Post-Gazette that 16 percent of its members received at least one opioid prescription in 2016, down from 20 percent in 2015.

Dr. Lauren Hughes, the Pennsylvania Department of Health's deputy secretary for health innovation, said it's too soon to say whether the declines are because of the new program.

But, she said, it is clear that both in Pennsylvania and nationwide, awareness is growing.

"What we're attempting to do here is create a cultural change on how to more safely prescribe," she said, noting that the state boards of medicine and pharmacy published new opioid guidelines this summer. "It's going to take a lot of effort for a long while for us to get there."

So far, so good

To date, Hughes said, the new monitoring program has been going well, fielding about 2.3 million queries.

"That's 2.3 million times that prescribers are asking to see data to make more informed decisions," she said. "We've been very pleased with the progress so far."

Hughes noted that although the monitoring program was initially voluntary, a law passed in the fall made it mandatory for opioid prescriptions starting Jan. 1.

Prior to the program's rollout, providers expressed concern that more scrutiny on opioid prescriptions might push more patients to illegal drugs like heroin.

Department spokeswoman April L. Hutcheson said that it doesn't have information on that but that the big-picture goal of the program is to identify people who might have an opioid problem early and help get them into treatment.

"If you need it, your doctor is going to prescribe it," she said. "It's not preventing opioids from being prescribed; it's giving prescribers the big picture as to where people are getting their prescriptions from."

In addition to the state's efforts, insurers, health systems, insurers and employers also are taking steps to address the problem of opioid abuse.

Patrick Stewart, president and CEO of Pittsburgh-based Innovu, said it is performing opioid analysis "for almost all of our clients on a monthly or quarterly basis."

The company, which helps employers assess health data, recently announced a partnership with The Business Group on Health, an independent affiliate of The Lancaster Chamber of Commerce & Industry.

Stewart said he thinks the new opioid guidelines are having an effect by now and that many insurers are making changes, as well.

For instance, Highmark recently added pharmacists to its care-management teams that help members who have multiple health issues. It said their role will involve "evaluating individual cases and advising the team on the safest, most effective therapies."

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