Health Insurers Help to Battle Overprescription of Opioids


Health Insurers Help to Battle Overprescription of Opioids

When study results published last month showed that physicians, aware that too many opioids are being prescribed, have changed their prescribing patterns, clinician executives at health plans welcomed the development — and with good reason.

The clinical use of opioids nearly doubled between 2000 and 2010, with simultaneous increases in the incidence of abuse, addiction, injury, and death, according to a study published in the Dec. 8, 2014, issue of JAMA Internal Medicine.

Nine out of ten primary care physicians who responded to the researchers’ survey say they are concerned that opioids are being overused, and half say they are less likely to prescribe them than they were a year ago.

“Primary care physicians appear to recognize many elements of the prescription drug abuse epidemic, such as the high prevalence of adverse outcomes associated with opioid use,” the study states.

Health insurers can play a vital role in curbing opioid abuse, says Don Liss, MD, vice president for medical management at Independence Blue Cross in Philadelphia.

“It is incredibly frustrating when physicians are not aware of the prescriptions their patients are receiving from other sources,” says Liss. “In the situation of prescription drug abuse, this is even more problematic, as a patient may not be forthcoming.”

The Johns Hopkins researchers selected 1,000 internists, family physicians, and general practitioners from the American Medical Association Masterfile and sent them a questionnaire last February. The results show that the response rate was 58%.

The results show that doctors are concerned but not gun-shy. Most (88%) expressed confidence in their clinical skills related to opioid prescribing, and nearly a half (49%) were “very” or “moderately” comfortable using these drugs for chronic noncancer pain, the survey found.

François de Brantes, executive director of the Health Care Incentives Improvement Institute, says that insurers should create tighter formularies that require some form of prior approval for certain medications.

In addition, he says, health plans should require the use of diagnostic codes on prescriptions. Today, prescriptions are transmitted by the physician to the retail or online pharmacy without any clinical indication for the problem related to the meds, de Brantes explained. Plans, analysts, and researchers must infer the relationship between condition and prescription based on the diagnostic codes included in the office visit most proximate to the filling of the prescription, but that inference isn’t always accurate, he says

De Brantes says that doctors should put the reason for the prescription on the script and retail pharmacists should enter that reason into the claim system to get paid.