Insurer Task Force Releases Recommendations To Combat Opioid Abuse

Jun 12, 2018

Attorney General Mike DeWine’s insurer task force on opioid reduction has released a set of 15 recommendations, but the list sticks to broad concepts rather than digging into specifics.

The recommendations offer general ideas to limit drug supply, identify abuse and improve treatment, but they leave the hard work of developing policies to each insurer individually.

Molina Healthcare medical director Mario San Bartolome believes that’s important, because each provider serves a different population.

“I think that every health plan is going to have kind of a unique group of folks that they serve and so the problems might be slightly different,” San Bartolome says. “So even though these are broad, in some ways, I think the intention is to be able to have somebody look at the specifics that they can do within that particular realm for their particular group."

Miranda Motter, president and CEO of the Ohio Association of Health Plans, echoes his sentiment. And she adds even if the language is loose, all the insurers are pointing in the same direction.

"You know while they may appear in broad strokes, there is a lot of evidence based support behind each one of them that really provides a certain level of uniformity," Motter says.

Among the group's recommendations:

Prevention

  • Insurers should cover and encourage, where appropriate, the use of both nonopioid pain medications and alternative treatments to manage pain.
  • Insurers should identify and develop targeted education efforts for prescribers who write a high volume of opioid prescriptions compared to others in their specialty.
  • Insurers should ensure providers are aware of and follow appropriate opioid prescribing guidelines, which should be more uniform.
  • Insurers should develop targeted prevention efforts to reduce the number of opioid prescriptions written for adolescents and young adults who are “opioid-naive.”
  • Insurers should develop education programs aimed at individuals who are receiving their first opioid prescription to make them aware of the risks of long-term opioid use.
  • Insurers should work together to develop common, easy-to-understand communications strategies to educate the public about the risks of opioids.

Intervention

  • Insurers should educate prescribers about properly decreasing opioid dosages to reduce patients’ dependence on opioids.
  • Insurers should create, use and continually refine programs to reduce the practice of doctor or pharmacy “shopping” by patients who are seeking opioids.
  • Insurers should use multi-disciplinary teams to coordinate care for members with opioid-use disorder.
  • Insurers should direct obstetricians and gynecologists to screen pregnant patients for opioid use throughout pregnancy to reduce the serious health risks for infants.
  • Insurers should accept a standard authorization form for disclosure and use of protected health information to better coordinate care.
  • Insurers should help government partners to coordinate substance-use treatment for patients preparing to re-enter the community after a period of incarceration.
  • The Ohio General Assembly should amend state statute so that commercial insurance companies have access to prescription information contained in the Ohio Automated Rx Reporting System, the system designed to collect data on outpatient prescriptions for controlled substances.

Treatment

  • Insurers should eliminate or expedite prior authorizations for accessing Medication Assisted Treatment to reduce the amount of time a patient must wait to receive treatment.
  • Insurers should increase reimbursement rates to adequately cover the cost of providing substance use disorder treatment.

According to provisional figures from the Centers for Disease Control, Ohio trails only Pennsylvania and Florida in drug overdose deaths from November 2016 to October 2017.