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    Four PBM programs poised to rein in the opioid epidemic


    3. Express Scripts’ advanced opioid management solution

     This program is designed to lower risk of overuse and abuse at three critical touchpoints.

    1. At the pharmacy. This touchpoint includes:

    • Restrictions for first-time users of short-acting opioids to an initial fill days’ supply of seven days.

    • Enhanced prior authorization for all long-acting opioids to block fills for new users.

    • MED edits giving visibility to and requiring prior authorization for members accumulating quantities of opioid medication exceeding 200 mg morphine equivalent dose/day.

    • A concurrent drug utilization review to ensure opioid prescriptions are appropriate and medically necessary.

    2. With physicians. “We send automated messages directly to all opioid-writing physicians at the point-of-care via their electronic health/medical records portal to inform them of potential duplicate therapy, misuse and abuse, drug-drug interactions, use of multiple prescribers or pharmacies—or when their patient is approaching morphine equivalent dose thresholds,” says Snezana Mahon, PharmD, vice president of clinical product development at Express Scripts.

    3. With patients. This touchpoint includes:

    • An educational letter sent after the first fill to educate members of the serious potential risks of opioid use, safe handling instructions, important restrictions, and proper disposal of unused medication.

    • Proactive outreach to patients by opioid neuroscience specialist pharmacists. Outreach is triggered when data signals concerning patterns of use, for example, filling two or more different short-acting opioids within the last 30 days.

    • Distribution of deactivation disposal bags to first-time opioid utilizers who Express Scripts data indicate are likely to have leftover medications. The bags include clear instructions for handling and disposal in members’ homes—no driving or special disposal day required.

    • Limiting patients to one prescriber and one pharmacy when certain alerts are triggered.

    “Driving change in the opioid crisis requires addressing the full care continuum, and influencing behavior at every touchpoint,” says Mahon. “Drug utilization management alone is not the answer. To impact care and costs, doing the minimum won’t do anything. Simply put, plan sponsors need a treatment plan, not a bandage.”

    Next: CVS' enterprise initiative



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