WellCare pilot program reduced opioid dispensing by 50%

As the nation continues to grapple with the opioid epidemic, a health insurer that sells plans in one of the hardest-hit states says it has achieved promising results from a pilot program aimed at reducing abuse and misuse of potent prescription painkillers.

WellCare’s pharmacy management pilot program, which began in December 2016, achieved a 50% reduction in opioid dispensing among 1,300 members in the company's Kentucky market. The pilot also resulted in a 35% decrease in the dispensing of the common muscle relaxant cyclobenzaprine, and a 30% reduction in the dispensing of benzodiazepines, a class of psychoactive drugs.

Those chosen to be involved in the pilot were first identified as being at risk for opioid misuse or abuse based on criteria including prescription dispensing, prescription refills, pharmacy use and emergency department utilization. WellCare connected these members to one pharmacy and one healthcare provider, as well as a care manager with specialized training and experience in substance abuse treatment, who helped connect members to any necessary physical, behavioral, pharmacy and social services.

This multipronged approach is key when tackling a problem as complex as the opioid epidemic, Howard Shaps, M.D., senior medical director of WellCare of Kentucky, said in an announcement of the pilot results.

Mark Leenay, M.D., WellCare's senior vice president and chief medical officer, added that the insurer plans to integrate best practices that it learned from the pilot into current programs that it’s undertaking across its Medicaid markets.

"As a leading provider of managed care services, WellCare has a responsibility to help curb the opioid epidemic, not only in Kentucky, but across the country," he said.

WellCare’s initiative is one among many that health insurers, both large and small, have taken to try to address the opioid epidemic. Aetna, for example, conducted outreach to opioid “superprescribers,” while Anthem reduced the number of opioid prescriptions filled by its members by 30%.

However, some have argued that insurers are still contributing to the crisis. During a recent meeting of the president’s Commission on Combating Drug Addiction and Opioid Crisis, former Congressman Patrick J. Kennedy said payers have historically been reluctant to cover mental health and addiction treatment.

And Rep. Elijah Cummings, D-Md., requested data from major health plans and pharmacy benefit managers to determine whether their pricing policies steer patients to cheaper, more addictive painkillers.