Anthem Health Plans Reduce Opioid Prescriptions Filled at Pharmacy by 30%

Corporate goal was met two years early

Health plans affiliated with Anthem, Inc., have reached the company’s collective goal of reducing opioid prescriptions members filled at pharmacies by 30% during the past five years.

The Anthem health plans were among the first to limit coverage for short-acting opioid coverage to seven days for all individual, employer-sponsored, and Medicaid members beginning new opioid prescriptions. The policy does not apply to those who have cancer or sickle cell anemia or those who are receiving palliative care.

The goal was originally expected to be achieved by 2019. The primary reason for the quantity limits was to prevent accidental addiction and opioid use disorder, and to ensure clinically appropriate use consistent with Centers for Disease Control and Prevention (CDC) guidelines.

Anthem also evaluated reductions based on the past year when its health plans accelerated health policies in various states and plans. In the past year alone, plans demonstrated large decreases in opioid use. For example, Medicaid plans showed a 29% reduction in Virginia, 22% reduction in Maryland, and a 9% reduction in Georgia, while employer-sponsored and individual plans decreased opioids by 23% in Nevada, 17% in Connecticut, and 17% in Wisconsin.

“We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, reduce, and more effectively treat opioid use disorder among our members,” said Dr. Sherry Dubester, Anthem vice president of behavioral health, who leads the companywide effort to impact the opioid epidemic.

Drug overdose is the leading cause of accidental death in the U.S., exceeding car crashes and guns. From 2014 to 2015, drug overdose deaths increased by 5,349, or 11.4%, signifying a continuing trend observed since 1999, according to the CDC.

Anthem-affiliated health plans 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 Anthem quantity limit changes 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 who have terminal or chronic illness.
  • Pharmacy Home programs exist for individual, employer-sponsored, Medicare, and Medicaid 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 a letter, including when the member has prescriptions for both Suboxone and opioids or is on persistent high doses of opioids.

With more than 74 million people served by its affiliated companies, including more than 40 million within its family of health plans, Anthem is one of the nation’s largest health benefits companies.

Source: Anthem, Inc.; August 23, 2017.