Helping Doctors, Protecting Patients

Aug 21, 2017
Advanced Opioid Management is more than just utilization management: it’s also about patient education and care, proper disposal of unused medication, and using data to monitor for, and intervene in, suspected patterns of abuse.
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  • Pain

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There is no shortage of staggering statistics to illustrate the seriousness of our country’s opioid epidemic. The data tell a frightening story about the problem and what behaviors contribute to it. For example, I can tell you that:

  • One in five users who start on a 10-day supply of opioid medication become long-term users.
  • Nearly half of patients who take opiate painkillers for more than 30 days in the first year of use continue to use them for three years or longer.
  • The median time from first opioid prescription to overdose for opioid-related overdosing patients is just more than 2.5 years.
  • One in 32 people who accumulate morphine equivalent doses above 200mg die from overdose.
  • 6 out of every 10 American households have unused opioids.
  • 70 percent of abused prescription medications are obtained from family and friends.

However, you don’t need data to understand the magnitude of the issue. Opioid use is so prevalent, it’s almost certain you know someone who used an opioid medication and received more than they needed. As my team and I built our Advanced Opioid ManagementSM solution, we discussed — and were shocked by — stories of family and friends, and even personal experiences, of receiving an excess amount of opioid medications for bone fractures, back pain or dental procedures. One team member said a family member received a 30-day supply of Percocet — 360 pills total — following a minor knee procedure. That’s 12 pills per day for an entire month.

Common sense tells us 360 pills for minor, outpatient procedure is unnecessary. Clinical research tells us that excess medication is dangerous to the patient’s health, increases the risk of addiction and is a rich pipeline for people who seek to abuse opioid medications. Yet despite common sense, prescribing guidelines, and the abundance of clinical research, this overprescribing continues, fueling an epidemic that grows worse each day.

In addition to the tragedy of opioid misuse is the fact that our nation’s employers are paying for one-third of the opioid medication that ends up being misused. So when it comes to addressing one of the root causes of this problem, our nation’s employers are in position to make a significant difference.

Our clients understand this crisis that is damaging to their benefit plan members and their families. They ask us every day “how can we do more to address the overprescribing and misuse of opioids?” Our answer — a comprehensive and measurable one — lies in our new solution.

Advanced Opioid Management is more than just utilization management: it’s also about patient education and care, proper disposal of unused medication, and using data to monitor for, and intervene in, suspected patterns of abuse.

The program was created using CDC prescribing guidelines and was pilot-tested in our Lab. It seeks to address overprescribing while also making sure those who rely on these medications have access to them without delay. Utilization management requirements do not apply to patients who are on hospice, in palliative care or have cancer.

This program is not intended to interfere with a physician’s care. A key element is actually empowering physicians with more patient data as they make opioid prescribing decisions. It helps physicians who may be unaware their patient has accumulated an unsafe amount (more than 200 mg morphine-equivalent dose/day) of opioid medication. This is a frequent occurrence with prescribers due to patients who see multiple physicians, and even patients who may be doctor shopping for these medications.

Through a prior authorization request, physicians can provide additional information to the plan so their patients can obtain coverage for a longer-term supply or a long-acting opioid, as needed. This standard industry protocol may be an extra step for prescribers, but will protect patients and their families by reducing excess medication within homes.

At Express Scripts, it is our duty to protect our patients, and make medicine safer and more affordable. We believe our comprehensive program, which combines education, care coordination and utilization management across the care continuum, will make a meaningful difference for patients and their families.

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