The number of opioid prescriptions has steadily declined among Blue Cross Blue Shield members over the last five years, with a handful of states seeing prescription rates drop more than 40%.
That decline is due is due to a mix of new coverage restrictions by the insurer, as well as physician outreach that helped providers modify their prescribing patterns in certain circumstances, according to Trent Haywood, M.D., the chief medical officer of the BCBS Association.
“In most clinical situations, opioids should not be prescribed as a first-line therapy,” Haywood said. “Providers around the country are recognizing that to be a reality—that the evidence doesn't really support opioids in most situations."
Nationally, the number of prescriptions filled by BCBS members decreased 29% between 2013 and 2017, according to the most recent data (PDF) released by BCBS Association last week. In some states hardest hit by the opioid epidemic—including Massachusetts, Ohio, New Hampshire and Mississippi—prescriptions decreased more than 40%.
The number of BCBS members with short-term, low-dose prescriptions increased 40% or more in 48 states, including 10 states where that number increased 50% or more. Perhaps more importantly, the number of members who filled an opioid prescription at all decreased 25% over that five-year time span.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis focused heavily on provider education as a strategy to negate the opioid epidemic in its report last November (PDF). But Haywood says education alone isn’t enough.
“You can educate, but that doesn't necessarily lead to modifications in behavior patterns,” he said, adding that BCBS plans "reached an agreement" with providers to modify their prescribing patterns.
Providers in Michigan, for instance, looked back at surgical situations where they would have written opioid prescriptions “instantaneously,” Haywood said. Instead, those providers recognized "they could modify their prescribing practices and not necessarily require opioids as a first-line therapy for pain management.”
On the coverage side, BCBS plans did what many other insurers have done, requiring prior authorization for opioid prescriptions beyond seven days, and placing new restrictions on high-dose prescriptions.
“This is great news related to a reduction in primary prevention,” Haywood said, but he added that BCBS still has work to do in terms of secondary and tertiary prevention.
Later this year, Haywood said the insurer plans to focus on effective substance abuse treatment, including a national hotline for members with opioid abuse disorder.