States tackle spiraling drug costs

Through a precertification program launched in 2012, Blue Cross Blue Shield of Massachusetts reduced prescriptions for opioids such as Percocet by 20 percent and halved the prescription volume for longer-lasting painkillers such as OxyContin, The Boston Globe reported.

BCBSMA implemented the program after learning that over 30,000 members received drugs such as Percocet and Vicadin for prescriptions longer than 30 days.

Under the new program, patients may fill a 15-day prescription for short-acting opioids and one additional 15-day supply, but later medication requests require member evaluations for addiction risk and treatment plan agreements with their prescribers, The Globe reported. For longer-lasting painkillers, precertification now is always required.

However, the new program's requirements don't affect cancer patients and members with terminal illnesses, The Globe noted.

BCBSMA's program also aims to reduce doctor shopping by notifying practitioners when members receive painkillers from three or more prescribers within six months.

Meanwhile, substance abuse professionals in Vermont are urging payers to cover addiction prevention services, according to The Bennington Banner. Health officials told lawmakers that commercial insurers have largely ignored drug abuse screening and post-treatment relapse prevention efforts as cost-effective ways to manage abuse.  

Drug prevention services in Vermont cost an average of $9.28  per person last year, according to the state's health department. And the monthly rate for people receiving medication-assisted drug treatment in a hub is $500 per patient, The Banner reported.

The state now is funding these services through grants, though Blue Cross Blue Shield of Vermont is "working out contracts" to cover hub services, the article stated.  

Efforts in Massachusetts and Vermont align with other state actions against overprescribing in response to rising opioid-related deaths. Primary care doctors in Washington, for example, consult with pain specialists before prescribing daily morphine-equivalent doses of 120mg or greater, the first dosage threshold of its kind nationwide, as FiercePracticeManagement reported.

For more:
- read the Boston Globe article
- see the Bennington Banner article

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