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Health insurers’ role in fighting the opioid crisis

Here’s a frightening but effective illustration of the U.S. opioid crisis: Reports released earlier this month show that more Americans are dying every year than we lost in the entire Vietnam War. We tragically lost 58,000 U.S. service men and women in Vietnam. Last year, reports place opioid deaths at 59,000 to 65,000, and we’re on pace to exceed that in 2017.

As I work with Southeast Wisconsin health leaders and community action groups, I’m often asked about the role health insurers can play in curbing this horrific trend. It’s an important question because health plans can and must play a big role. Let’s look at what Anthem Blue Cross and Blue Shield is doing as one example, but first a little background.

How did we get here?

A growing body of experts points to the overprescribing practices of prescription opioids that have led to misuse and abuse by many Americans. CDC data estimates that the number of prescriptions for opioids written in the United States has skyrocketed over the past 25 years.

A national solution to combat the epidemic is complex, and requires action and cooperation across the health care ecosystem – from providers, payers, and federal regulators – to enable a system that supports evidence-based care through addiction prevention and access to treatment.

Anthem ambitiously committed to double the number of consumers who receive behavioral health services as part of medication-assisted therapy for opioid addiction. To address the continued overuse of opioid prescriptions, Anthem and its sister plans across the country aim to reduce the amount of opioids dispensed to their members by 30 percent from historic peak levels by the end of 2019.

What have we learned?

For the last year, a dedicated group of Anthem medical directors, nurses, pharmacists, care managers and benefits experts have worked closely to re-examine policies and provide new insights into the role of payers to help support access to comprehensive treatment.

The results from Anthem’s internal research of member claims with medical and pharmacy benefits identified treatment gaps left in current health plans, showing that members are not getting the best combination of behavioral health and drug therapy to combat addiction. Results showed that of those members who received buprenorphine products for medication-assisted treatment (MAT), only about 16 to 19 percent of the members taking the medications for opioid use disorder also were getting the recommended in-person counseling.

What will we do now?

To help prevent opioid misuse and abuse before it starts, all Anthem-affiliated individual, employer, and government-sponsored health plans have begun implementing quantity limits on short and long-acting opioids.

As part of our goal to increase access to comprehensive treatment, Anthem is introducing standardized MAT coding for psychiatrists and non-psychiatrist doctors certified to support MAT to help maximize reimbursements and streamline the reimbursement process for subsequent visits. Additionally, we are working to connect non-psychiatrist MDs with behavioral health support to systemize counseling for people also receiving drug therapy.

To further support access to MAT, Anthem removed the prior authorization for oral buprenorphine that was intended to help ensure clinically appropriate use, including that the member was enrolled in comprehensive counseling services.

As more research is conducted and new evidence is discovered, Anthem will continue to evaluate its programs and policies on an ongoing basis to support access to comprehensive treatment for addiction.

Collaboration is the key

Like smoking and obesity, the key to addressing a complex social health crisis like opioids is attacking it on multiple, coordinated fronts. Anthem will continue to collaborate across the health care ecosystem to tackle this complex issue and help people lead their healthiest lives.


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Nobile is a 20-year veteran of the insurance industry whose experience includes time with Rush Prudential Health Plans, Aetna, and United Healthcare. Prior to joining Anthem, Nobile served as the Director of Sales and Account Management for the Midwest region at UniCare, a health benefits company based in Chicago and owned by Anthem’s parent company and also ran UniCare’s Eastern Region with offices.

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