Insurers announce new anti-opiate measures

Dec 27 2017

Insurers announce new anti-opiate measures

Two of the nation’s largest health-insurers, Aetna and CareFirst Blue Cross Blue Shield, have announced new initiatives aimed at containing the opiate epidemic.

Effective January 1, Aetna will become the first national payer to waive copays for Narcan for its fully-insured commercial members, a step intended to make the lifesaving drug more accessible and affordable for those who need it.
Narcan is a preferred branded medication, which may currently require a copay for members.

The current copay for Aetna members ranges from $0 to $150, depending on the plan selected, but is typically in the $30 to $40 range, the health plan says. The copay would be waived for fully-insured commercial members once their deductibles have been met.

The insurer reported that nearly 35 percent of members who were prescribed Narcan between January and June of this year did not pick up their prescriptions, probably due to cost. Aetna also reported its members were more likely to skip a Narcan prescription as copays increased. About 77 percent of prescriptions were abandoned when copays were between $100 and $150, and 46 percent were abandoned with copays between $40 and $50.

Aetna also plans to limit acute or post-surgical prescriptions to seven days for patients who are taking opioids for the first time. Both changes will be effective Jan. 1, 2018.

CareFirst Blue Cross Blue Shield, the largest health insurer in the Baltimore-District of Columbia region, announced that it will invest $1.5 million in nonprofit community health organizations to treat substance abuse disorders. CareFirst will issue a request for proposals to regional nonprofits in January and will award the funding to nonprofits in the Baltimore, D.C. and northern Virginia region in early 2018, according to the announcement.

CareFirst also launched new quantity and duration limits for opioid prescriptions in October, and formed a Behavioral Health and Substance Abuse Disorder Program that providers can use to refer members to substance abuse treatment.

“The impact of opioids in the region we serve has been well documented,” CareFirst CEO Chet Burrell said in the announcement. “As the region’s largest health insurer and one with a unique community mission, we want to take a comprehensive approach to address the opioid crisis for the greater community.”

CareFirst is also continuing to expand its network of covered addiction recovery centers, according to the announcement.

Commenting on CareFirst’s announcement, Baltimore Mayor Catherine E. Pugh said the City Health Department has developed a comprehensive, three-pillar strategy to combat opioid addiction: prevent deaths from overdose and save lives, increase access to on-demand treatment and long-term recovery support, and provide education to reduce stigma and prevent addiction.

“But, this is one of those situations which you can never do enough to address, and where you always welcome additional partners and resources,” the mayor said.

CareFirst CEO Chet Burrell said that within the last few years, his company began noticing increasing signs of opiate overuse, in its member claims. Data showed indications some providers were prescribing more opiate painkillers, and that some plan members were getting prescriptions from multiple physicians.

“We started realizing what we were seeing, it wasn’t just a blip, it was a sustained societal problem,” Burrell told the Baltimore Business Journal. He said at least 250,000 of CareFirst’s roughly 2 million members have been prescribed opioids; the plan detected indications of substance abuse or indication in about 10 percent of those.