Opioid Crisis Prevention, Strategy and Treatment
The opioid and heroin abuse epidemic is a profound public health problem in the United States. Opioid abuse killed an estimated 59,000 Americans in 2016. A crisis of this magnitude will have an impact on the workforce, affecting not only employees of HR Policy member companies, but their families and communities as well. In order to help combat opioid abuse, the HR Policy Association has compiled insights from Association members on their policies and strategies regarding the opioid crisis. You can find these below, along with resources used and recommended by our member companies.
- HHS: Opioids: The Prescription Drug & Heroin Overdose Epidemic
- CDC: Opioid Overdose Homepage
- American Association of Nurse Anesthetists: Opioid Crisis Resources
- Harvard Kennedy School: Opioid Crisis Resources
- "The Opioid Epidemic: Assesssing Your Organization" by Henry C. Eickelberg
- "Yes, Employers Need to Begin Discussing the Impact of America's Opioid Crisis on Employees and the Workplace" by Jeff McGuiness
- "Opioid Abuse Is a Public Health Crisis—Here’s How Trump Can Beat It" by Tevi Troy
- "A Painful Epidemic" by Julie Cook Ramirez
Input From HR Policy Association Members
CVS Health Corporation
Each day, our pharmacists are busy helping people on their path to better health, and that includes dispensing prescription medications that help patients fight pain, sleep more soundly, and overcome anxiety. But when these drugs are abused, there can be unintended consequences. Our commitment to patient safety includes educating our patients on how to take these medications appropriately and working in our communities to help prevent prescription drug abuse and misuse. There is no one solution to this epidemic. We use multiple strategies to address the issue, including combating prescription fraud through analytics, expanding access to safe overdose treatments, educating youth and families about the dangers of abuse, and working to ensure the proper use and disposal of medications.
Fighting Prescription Fraud
Techniques for forging prescriptions have become more sophisticated and increasingly difficult for our pharmacists to identify. In 2016 we rolled out an advanced analytics platform leveraging CVS Health’s dispensing data to help detect suspected forged prescriptions. The platform reviews prescription data to detect prescribing anomalies associated with prescription forgeries, and then alerts the pharmacist to contact the prescriber to validate the authenticity of the prescription. This system complements our ongoing efforts to prevent drug diversion by identifying, investigating and stopping the filling of controlled substance prescriptions at our stores written by prescribers who exhibit questionable patterns of prescribing for high-risk drugs. In most states, every medication dispenser must report the dispensing of controlled substances to that state’s Prescription Drug Monitoring Program (PDMP). A PDMP is utilized by pharmacists, prescribers, law enforcement, prosecutors and others to prevent fraud and diversion. We require all of our pharmacists to be registered users of their state’s PDMP.
Facilitating Overdose Treatment
Naloxone, also known as Narcan®, is a safe and effective antidote to an opioid overdose. We helped advocate for states to allow pharmacists to dispense naloxone pursuant to a physician’s standing order to patients who do not have a prescription, and by the end of 2016, 37 states allowed it. We will continue to participate in these programs as more states adopt enabling laws and regulations. We also participate in a number of pilot programs to increase naloxone awareness and visibility.
Education and Awareness about Drug Abuse
Preventing prescription drug abuse requires education of patients, families and communities. In 2016 we launched the Safer Communities website for patients and families with questions about prescription drug abuse. The site centers around three key measures for controlling prescription drug abuse: taking medications as prescribed, keeping them safe and secure in the home, and disposing of them properly. Our Pharmacists Teach® program brings local pharmacists to high school health classes to talk about a variety of health topics. In the fall of 2015 we launched a new curriculum for students in grades 7-12 focusing on the choices students make and the dangers of prescription drug abuse. Our pharmacists volunteer their time to go to schools and offer their unique perspective to dispel the widely held belief in this age group that prescription drugs are safer to abuse than street drugs. Students learn the facts and hear stories of other teens whose lives were forever changed by their choice to misuse or abuse prescription drugs. By the end of 2016, pharmacists had given more than 4,200 of the 30-minute presentations, entitled “One Choice Changes EverythingTM,” reaching more than 170,000 students. In 2017, we are expanding Pharmacists Teach to reach parents as well and we have developed a new target:
- Increase pharmacist community outreach to educate youth and families by reaching 750,000 individuals by 2020.
In the fall of 2016, the CVS Health Foundation supported a campaign through DoSomething.org, called Explain the Pain Text, that asked young people to share an SMS text message resource with friends to educate them on ways to keep friends safe from prescription pain medication abuse and misuse. Participants received a short, 10-minute SMS experience with tips on how to help someone suffering from addiction and ways to keep their community safe. More than 69,000 people participated through the DoSomething.org platform, which is dedicated to empowering young people on social issues.
Ensuring Proper Disposal
Excess or expired medication must be disposed of properly. Medications that are flushed can impact local streams and lakes. Unsecured medication that remains in medicine cabinets may get into the wrong hands: more than four in 10 teens who have misused or abused a prescription drug obtained it from their parents’ medicine cabinet. In collaboration with the Partnership for Drug-Free Kids, CVS Health created the Medication Disposal for Safer Communities Program, through which local police departments can apply to receive a drug collection unit. This program strengthens an existing network to approximately 3,500 collection sites across the country. To date, we have donated more than 762 units in 43 states and have collected more than 81.6 metric tons of unwanted medication. We also continue to support National Drug Take-Back Day by hosting law enforcement drug collection events in our parking lots. Also in 2016, we launched a public-private partnership with the City of Milwaukee that helps patients dispose of medicines from their homes. In this two-year pilot program, residents can place medicines in return envelopes distributed at 10 CVS Pharmacy locations and select public locations. If successful, we will explore expanding the program to other municipalities.
Hallmark Cards, Inc.
The benefits that Hallmark would use in dealing with this crisis are medical and EAP. Fortunately, this is not an major issue we are directly faced with at this time.
MEDICAL: During our annual reviews with medical carriers, the opioid addiction was not raised as an impacting trend for our plan. We have had individuals or their dependents have a need for treatment, but these cases seem to be relatively rare. We checked with the carriers on broader actions being taken to address the opioid crisis, and we have heard from one, UHC.
Over the past decade, UHC has been investing in multi-dimensional programs to help reduce the abuse of opioids while providing patients with both temporary and chronic pain access to safe and effective treatment—including non-opioid options. For plans such as ours, they have taken the following actions:
- They use data analytics to identify plan participants who are at increased risk of opioid dependence due to a high number of prescriptions from multiple doctors, pharmacies and physicians.
- To help prevent abuse, they have implemented a “Pharmacy Lock-In” program. Once plan participants are enrolled in this program, the participants must obtain their prescriptions from a single pharmacy, reducing the likelihood of overprescribing or conflicting prescriptions.
- To aide those with addictions, they have eliminated Prior Authorization requirements for preferred medications that are used to treat opioid dependence, and they have added coverage for medication assisted treatment such as Patient Substance Use and Treatment Helpline and medication assisted therapy providers who actively integrate medical, behavioral and pharmacy treatments to help reduce opioid abuse and dependence.
- They also use data analytics to identify physicians with a practice of excessive dosing of opioids, excessive duration of opioids, and dangerous combinations of opioids with central nervous system depressants such as benzodiazepines.
EAP: Our EAP provider has many resources available dealing with pain medication use/misuse, including guidance consultants, professional counselor referrals, and online resources. We know that the provider regularly adds information to address current needs. In the Q1 summary of utilization, 2% of searches online pertained specifically to addiction.
In summary, I do not have any evidence to suggest that for Hallmark, the trend of drug abuse or addiction treatment has increased over the past 6 years.
At Textron, while we have not had any policy changes, we did make a RX process change with our Pharmacy Benefit Manager, specifically for the synthetic opioid, fentanyl. Fentanyl was originally FDA approved for use in cancer patients with break-through pain. The process requires that medical evidence be submitted for diagnosis of cancer (for cancer-induced pain) before a pharmacy prescription can be filled. We do not have a prohibition of its administration in a hospital by qualified medical professionals.
Duke Energy Corporation
Duke Energy has a safety/monitoring program in effect with our PBM that monitors for patients “shopping” multiple doctors and pharmacies to secure unsafe quantities or overuse of medications, including opioids. In some cases this program restricts the member to using only one pharmacy nearest their home.
We are also considering additional utilization management programs the PBM has developed in conjunction with recent CDC guidelines on opioid prescribing to identify members who may be taking higher than CDC recommended amounts. These programs should also help slow the growth of patients newly becoming addicted to opioids.
Yum! Brands Inc.
Beginning June 1st, Yum! began covering a benefit, Medicated Assisted Treatment (MAT), to help treat opioid use via United Health Care. The MAT treatment looks at opioid use as a chronic condition, not a onetime only, one size fits all solution like most detox programs. MAT combines behavioral therapy and medications to provide a “whole-patient” approach to the treatment of substance use disorders. The prescribed medications block the euphoric effects of opioids to relieve cravings without the addictive effect of opioids. UHC has built the largest MAT-contracted network in the country.
Newmont Mining Corporation
Newmont implemented the Express Scripts (ESI) Fraud, Waste and Abuse Program (FWA) to proactively protect our plan from the cost associated with fraudulent prescriber and patient activity. The program provides analytics of relationships, patterns, and scenarios. It identifies and review outliers such as a member receiving multiple drugs from multiple physicians and multiple pharmacies. Suspicious activity is flagged for investigative review. If an investigation leads ESI to believe there is fraud or abuse occurring then the member receives a letter to explain that they have been restricted to filling scripts through our program at one pharmacy and/or prescriber for all controlled substances and muscle relaxers for their safety.
Newmont is also currently evaluating Express Scripts newly released Opioid Management program.
Bristol-Myers Squibb Company
Based on our recent Pharmacy Benefit data, BMS has not experienced an issue with opioid abuse. First time fills make up more than 92 percent of the prescriptions written in this class, with less than 1 percent being for a fourth or greater refill. Several years ago, we implemented a Prior Authorization process for opioids that are beyond normal prescribing limits, duration or diagnosis. Our Pharmacy Benefits Manager receives very few requests for exception to these limits.
Rockwell Automation, Inc.
Rockwell Automation is headquartered in Milwaukee County, Wisconsin, which is one of the areas highlighted with one of the most significant opioid abuse problem. While our mental health claim data and our prescription drug data does not suggest our employees or their covered dependents have significant issues with opioids we are concerned with this growing issue in the country and our area.
We want to ensure our Rx plan does not create negative unintended consequences for our members using opioid medications, so for 2018 we will be implementing quantity limits consistent with labeling guidelines established by the FDA for opioids. We will also begin to more closely monitor usage and are looking at appropriate interventions for frequent refills. We have also heightened awareness with our EAP vendor for response to member outreach.
Tenet Healthcare Corporation
We have not taken any steps other than quantity control (limits per script and over a specified period of time) when filling these important but highly addictive drugs. The problem we all have is that these drugs are incredibly cheap and when our plan limits kick in, the employee/dependent fills them outside the plan. This creates a problem for us not having the whole picture of what is happening with employees to allow for case management, etc. to take action.
In my opinion, several very important things need to take place to help with this epidemic.
- No prescriptions can ever be filled without a valid SSN.
Doctors need to be electronically linked into the various pharmacy programs so that they get automatic information regarding a patients pharmacy habits.
- This helps from a safety/drug interaction basis.
- Additionally, this allows them to facilitate discussions with their patient about alternative treatment options and seeking help for an addiction if needed.
- Similar to what doctors are doing with antibiotics (not prescribing as frequently and adhering to clinic prescribing guidelines), doctors should go “old school” and start the patient with traditional pain relievers and only go to opioids when all else fails.
- Finally, we need to use the robust electronic systems to identify doctors who are enabling abuse and take quick and decisive action against their medical licenses.
WESCO International, Inc.
We use Express Scripts and they have introduced a new program to address this.
- ESI limits initial fills to 7 days.
- Prior authorization is required as well as a concurrent Utilization Review.
- A medical edit check can be done across all known prescriptions to do a Morphine Equivalent Dose (MED) check.
- Letters are sent to home to educate reuse and disposal
- Safety interventions are offered at the point of sale
- Outreach if 2 or more different opioid prescriptions are filled
- Drug de-activation prescription disposal bags are mailed to enable disposal of unused opioids. Bag has a charcoal deactivation system.
- Alerts are sent to prescribing doctors regarding duplication and cumulative MED.
- A fraud, waste and abuse program enables a lock to be put on fills if FWA is detected.
ESI currently offers this as an additional service at 30 cents PMPM and says that the ROI is 10x.