Payers can play a critical role in helping tackle the opioid crisis, which not only threatens the nation’s health but also contributes to fraud, waste and abuse, according to a new white paper.
Because of their relationships with healthcare providers, pharmacies, insured patients, employers and even law enforcement, payers are in a powerful position to intervene in this public health crisis, says the paper, which was produced by the Healthcare Fraud Prevention Partnership.
Thus, a group of HFPP members—including major payers like Aetna, Cigna and Anthem and government agencies such as the Department of Health and Human Services—came up with five actions that they say “should be strongly considered for implementation by all payers as soon as possible.”
- Train providers on the Centers for Disease Control and Prevention’s “Guideline for Prescribing Opioids for Chronic Pain.” Payers should consider communication and incentive models that encourage providers to understand and adhere to the CDC’s recommendations, the paper says.
- Promote access to and usage of Medication-Assisted Treatment. Because adding MAT to behavioral therapy is more effective in treating opioid use disorders than behavioral therapy alone, the paper suggests this approach should be widely promoted and reimbursed.
- Promote the availability of naloxone. Reducing barriers to patients’ access to naloxone as well as reimbursement for the drug prevents the “catastrophic consequences” of ineffective management or misuse of prescription opioids.
- Encourage the use of data to identify and correct fraudulent, wasteful, or abusive practices associated with opioids. Data systems can help identify patients at risk for opioid use disorder as well as identify and prevent nonmedical use of prescription opioids and drug-diversion schemes, the paper notes. So it encourages payers to participate in studies that use cross-payer data to identify and act on fraudulent or wasteful activities across organizations.
- Identify and share effective practices across the healthcare sector. Payers should work together to communicate the best ways to identify at-risk patients, treat or prevent opioid use disorder, and identify providers whose prescribing practices fail to comply with CDC guidelines.
“Through coordinated action, payers, including members of the HFPP, have the opportunity to dramatically influence and reduce opioid misuse in the U.S.,” the white paper says.
In fact, insurers have already taken steps to mitigate the opioid crisis. Cigna, for example, eliminated prior authorization rules that can lead to delays for patients receiving MAT. And last week, Anthem announced that it set a goal of reducing the amount of opioids dispensed among its members by 30% by the end of 2019.