Insurance companies are responding to the drug crisis by increasingly clamping down on the overprescription of opioids, a step that could improve public health and their bottom lines.

With opioid misuse leading to addiction and other health problems, the insurers are using a variety of tactics to warn doctors and patients when doses are too high, or to investigate evidence of doctor shopping.

Opioids have fueled the drug crisis, as four out of five new heroin users were previously abusing prescription opioids, according to the American Society of Addiction Medicine. In Maine, a record 272 people died of drug overdoses in 2015, most from heroin, prescription opioids or fentanyl. About 25,000 to 30,000 Mainers want to start a drug treatment program, but don’t have access, according to federal statistics.

Maine now has one of the strictest prescribing laws in the nation, capping dosages and mandating use of the prescription monitoring program, which works to prevent doctor shopping.

Taking notice of the response by government and public health advocates to the opioid crisis, insurance companies are implementing policies designed to curb over-prescribing.

Emily Brostek, executive director of Consumers for Affordable Health Care, an Augusta-based advocacy group, said curtailing opioid prescriptions is in the financial interest of the insurance companies.

“It’s not just the right thing to do for the health of the public, but it also makes good business sense,” Brostek said. “These drugs are expensive, addiction treatment is expensive, emergency room care for overdoses is costly and it might save insurance companies from paying for other expensive treatments down the road.”

For instance, Aetna now sends a letter to doctors – excluding oncologists – who are in the top 1 percent of opioid prescribers to let them know that they are prescribing far more than their peers.

Meanwhile, Cigna has launched a number of programs with the overall goal of reducing opioid prescribing by 25 percent over the next three years.

And Anthem also is starting or developing strategies to cut back on unnecessary opioid prescriptions, including the “Pharmacy Home” program that’s designed to prevent doctor shopping. Patients often try to avoid being flagged for doctor shopping by using multiple pharmacies when filling prescriptions from different doctors.

Anthem, which launched the “Pharmacy Home” program in May, will require patients who use such tactics to receive their prescriptions at one pharmacy.

A pharmacist should notice when a patient is receiving multiple prescriptions for opioids from different doctors.

“When we see high dosages being prescribed, we’re doing more communicating with patients and prescribers,” said Tracy Harrell, Anthem’s director of clinical pharmacy. “There’s an epidemic, and too many are overdosing.”

Anthem also will warn doctors when they see a patient seeking painkillers from an emergency department and will investigate doctors who are prescribing high doses of opioids, she said.


Harrell said another program set to start this fall will notify doctors if a patient has previously been in a substance abuse treatment program or overdosed and gone to an emergency department, all warning signs that a patient may try to doctor shop.

In two other initiatives, Anthem is expected to work with doctors to expand access to medication-assisted treatment and start a telemedicine program that will assist with drug treatment counseling programs. The second program will be especially helpful in rural Maine, where patients have little access to treatment, Anthem said.

Mark Slitt, a Cigna spokesman, said the insurance company launched a program a decade ago to identify over-prescribing, and has been adding to it ever since.

“The opioid crisis is a national tragedy. Cigna’s goal is to work collaboratively with doctors, as well as organizations like (the American Society for Addiction Medicine) to help find ways to fix the problem.

Contacting doctors proactively regarding their patients’ risk factors is just one part of this effort,” Slitt said.

Dr. Stephen Hull, director of Mercy Hospital’s Pain Center, said insurance company policies to reduce over-prescribing will be helpful, but more needs to be done to lower America’s reliance on opioids to control pain. There are no long-term studies that prove the effectiveness of opioids in controlling chronic pain, scientists say.

Hull said his review of the research and the work Mercy Hospital has done on pain to use therapies for pain that don’t rely on opioids has convinced him that opioids are ineffective for chronic pain and carry many health risks.

But Hull said it’s taken a lot of work to have the program – which includes exercise therapy, behavioral and cognitive therapy, group sessions and other techniques to control pain – reimbursed by insurance companies. And Hull said some parts of the program are not reimbursed by health plans, and Mercy absorbs the cost to provide the service.

And Hull said programs like the Pain Center that do not rely on medication are rare.

“Doctors have not felt that they’ve had many alternatives to the prescription pad,” Hull said. “We need to offer some other choices for patients.”


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