“Prevention is preferable to cure.” These words are part of the modern Hippocratic oath guiding my work and the work of my fellow physicians across our state. Today we are facing a crisis that demands a preventive solution: prescription painkiller abuse.
The stakes are real. I’ve heard too many heart-wrenching tales of lives lost and families torn apart. We know many of these addicts never intended to be drug abusers, but began with a real need to treat pain from injuries or other medical conditions.
And the vast majority of prescribers are doing what is in the best interest of their patients to effectively manage pain. Yet despite good intentions and their best efforts, opioid prescriptions and addiction have escalated in the last decade, along with drug overdose deaths.
At BlueCross Blue-Shield of Tennessee, we covered one million opioid prescriptions for our members in 2015. That scale has given us deep insights on usage patterns that uniquely position us to help prevent painkiller abuse before it starts.
We launched a public health initiative in 2016 guided by an external panel of clinicians with pain management expertise. Our first goal is to educate prescribers on best practices for opioid use. Another is to change prescribing patterns and place quantity controls to reduce the harmful effects these drugs have on some members.
We began our phased approach this year with modest quantity limits and prior authorization (PA) requirements for new long-acting opioid prescriptions. The PA will ensure that providers are discussing a treatment plan and medication history with their patients before writing a prescription for chronic pain management.
Our intent was to phase in changes without throwing anyone into crisis. To date, we’ve been successful with only minor disruptions. It is also important to note we are granting immediate exceptions for members undergoing oncology and end-of-life care.
On Jan. 1, 2017, we implemented the next round of prescription pain medication changes based on CDC guidelines and provider feedback. These include a PA on all long-acting opioid prescriptions (new or current) for all members with BlueCross pharmacy benefits.
We also set new quantity limits on both long and short-acting opioids.
Finally, we’ve put in place morphine equivalent dose limits across all pain medication prescriptions. This will provide an objective standard and help manage the cumulative impact of the various opioid drugs a member may be prescribed.
The aim of our efforts is not to deny care or generate cost savings. Our only goal is to reduce the devastating effect that opioids (when overprescribed or not used as intended) have had on Tennessee families and communities.
We know these changes may be met with concern and resistance by some parties. But no one else in our state should have to suffer from painkiller addiction. No mother should have to be told her child has overdosed, and no child should have to be separated from their home as a result of a parent’s addiction.
The responsible steps we’re taking to prevent misuse and abuse are simply the right things to do.
(Dr. Andrea D. Willis is chief medical officer at BlueCross BlueShield of Tennessee.)
