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Joining a growing movement in fighting the nation’s opioid epidemic, Highmark Inc. announced policy changes and program expansions Thursday, including restricting opioid prescriptions for first-time users to seven days, and keeping track of opioid prescriptions to catch abuse.
The same or similar limitations have been adopted by two large national pharmacy benefits management companies, CVS Caremark and Express Scripts. Those moves, in turn, follow new guidelines proposed by the Centers for Disease Control and Prevention last year.
“In December, the CDC announced that the life expectancy in the United States dropped for the second year in a row, and drug overdoses are leading the way,” Chief Medical Officer Dr. Charles DeShazer noted during a media conference televised live on Highmark’s Facebook page. “64,600 people died from overdose in 2015. That exceeds the number of people who died of AIDS during the peak of that epidemic. That exceeds the number of people killed each year by car accidents and homicide combined.”
DeShazer laid blame for the opioid epidemic squarely on the shoulders of big pharmaceutical companies, saying they told doctors that studies showed they were not addictive when used for pain management, when in fact they were.
“Medical associations were convinced to prescribe opioids. Pain was considered to be the fifth vital sign, and treated the same way as high blood pressure.” Coupled with a movement toward seeing more patients in the same amount of time, doctors increasingly found it “easier to treat pain with opioids rather than go through trial and error to find the best pain management therapy.”
Highmark President Deborah Rice-Johnson stressed the epidemic requires working with others in the field, and noted Highmark has already been working with doctors and insurance members to make non-drug therapies such as acupuncture available. The company also works to make sure patients get the right drug in the right dose when drugs are prescribed.
Tighter restrictions on first-time prescriptions are being introduced because “data from the CDC show that people who use opioids for just one day have a six percent chance of becoming addicted,” DeShazer said, with the chance of addiction rising above 13 percent after using them for more than a week.
The seven-day policy also restricts first-time prescriptions to fast-release opioids, and requires prior authorization for a prescription of time-release opioids. The company will make exceptions for some cases if deemed best for the patient.
The company will also expand overuse monitoring that has helped reduce opioid addiction among members in West Virginia. The goal list is to prevent “doctor shopping,” when a addict goes to various doctors, hospitals or pharmacies to get new prescriptions that the original doctor refuses to renew. A patient could be restricted to using a single pharmacy.
Doctors who exhibit tendencies to over-prescribe would also be notified when such trends are suspected. “We want to get better tools to physicians, better information about pain management,” DeShazer said.
In West Virginia, overuse monitoring reduced the number of patients receiving drugs from multiple prescribers by more than 28 percent. Similarly, monitoring the prescription of opioids with other sedatives — increasing the risk of addiction — reduced the number of times such prescriptions were made by more than 25 percent.
“There is no silver bullet,” DeShazer conceded. “We must work with others to take meaningful steps.”