Changing the Way We Fight the Opioid Epidemic

Feb 20, 2018

We are driving change across the care continuum and influencing behavior at every touchpoint to minimize early exposure and prevent progression to overuse and abuse.

  • Pain


Plan sponsors fighting to combat the serious dangers of opioid misuse and abuse want the best opioid management solution on the market. Through Advanced Opioid ManagementSM, Express Scripts is working with clients to protect their members and their families, and early results demonstrate its working: Together with our clients, we are curbing opioid misuse with 60% lower average day supply per claim (down from 18.6 days to 7.5). We also influenced 95.9% of reprocessed scripts to be 7 days’ supply or less.

Our entire company is proud of this mission-driven work, the importance of which is reflected in this video. Or, perhaps most meaningfully in comments like this from Jim and Jeanne Moser, parents who lost their son to overdose and founded Zero Left: “We cannot express enough the importance of reducing excess medication in our homes and increasing patient education when opioids are prescribed. Programs like the one created by Express Scripts make a significant difference with every patient they touch.”

So how does the Advanced Opioid Management solution deliver on our mission? We are driving change across the care continuum and influencing behavior at every touchpoint to minimize early exposure and prevent progression to overuse and abuse.

At the Pharmacy

At the heart of our solution is our superior ability to influence and manage members’ safety interventions at the point of sale – a critical make-or-break moment in the continuum of care. In the first 90 days of the program, 87% of first time patients who were prescribed a long-acting opioid were redirected to a safer short-acting opioid.

Our pharmacy action plan is critical to protecting patients:

  • First-time users of short-acting opioids are restricted to an initial fill days’ supply of seven days. These edits are bypassed, however, when patients have a history of chronic pain requiring opioid therapy, have cancer or receive palliative care.
  • Enhanced Prior Authorization (PA) encourages safe-starts for all long-acting opioids, which should not be where members begin therapy.
  • Morphine Equivalent Dose (MED) edit gives pharmacy visibility to high doses of morphine equivalent dosing, alerting the pharmacy at doses of 90MME and 200MME. A prior authorization is required for members accumulating quantities of opioid medication exceeding 200mg morphine equivalent dose per day.
  • Tighter overall management is applied for specific opioid drugs.
  • As a reminder, our concurrent drug utilization review (CDUR) ensures opioid prescriptions are appropriate, medically necessary and unlikely to result in adverse medical consequences. CDUR provides real-time alerts to dispensing pharmacists to prevent adverse events.

With the Patient

Many people are unaware of the risks associated with opioid use, or even think “it won’t happen to me.” That’s why education and counseling are so important and impactful with opioid prescribing. We observed very positive results pilot-testing our education protocols for opioid use. In the first 90 days of our program, our Neuroscience Therapeutic Resource CenterSM (TRC) pharmacists have conducted hundreds of hours of conversations with patients about opioid risks and safe disposal. We also have sent more than 25,000 education letters and nearly 6,400 drug disposal bags to members with an opioid prescription.

Education, outreach, disposal and auto-lock management are key on the patient level.

  • Member education should start at first fill. Our solution proactively educates members new to opioid therapy via member-friendly outreach pointing out the risks and simple safety tips for taking their new opioid prescription, and proper disposal of unused medication.
  • Advanced member care via specially trained opioid specialist pharmacists at Express Scripts’ Neuroscience TRC complements our member letter. Proactive private and customized outreach is triggered by one of four proven trigger warnings from our proprietary data sets and modeling signals concerning patterns of use.
  • Safe handling and proper disposal of leftover medications will also help members via our simple-to-use deactivation kits, who need a safe, yet easy way to dispose of unused opioids.
  • Enhanced Fraud Waste and Abuse (FWA) auto-lock management of pharmacies enables earlier intervention to decrease misuse or abuse – yielding an average 20% annual increase in fraud detection.

With the Physician

The opioid crisis starts when over-prescribing occurs. Our program aims to support physicians who prescribe these medications through greater coordination of care and communication. We’re providing physicians with data-driven information so they can make better informed prescribing decisions for patients:

  • Through Express Scripts’ proprietary clinical rules engine, we identify and send daily alerts to opioid-prescribing physicians via their Electronic Health/Medical Records (EHR/EMR) so they are aware of potential duplicate therapy, misuse and abuse, drug-drug interactions, use of multiple prescribers or pharmacies, or when their patient is approaching MED thresholds.
  • Physicians will see how pharmacies and other prescribers are contributing to a member’s opioid claims and other vital information they are not usually equipped with, such as  member’s cumulative morphine equivalent dose.
  • For higher risk members, prescriber(s) will receive a message recommending to add Naloxone which can prevent opioid overdose/death, building upon the existing MED point of care alert.
  • Educational messaging about opioid prescribing best practices to prescribers based on area of practice, include their customized prescribing patterns for comparison and comparison to peers.

Make an impact

With this solution, clients stay ahead of additional government regulation to address the rising tide of opioid abuse and demonstrate innovation and commitment to solving a serious national problem. Together with our clients, we are personally, directly contributing to stopping our nation’s deadly opioid crisis. Contact your Express Scripts representative to learn more about how Advanced Opioid Management can reduce your costs and keep members healthier.

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