News & Commentary

Addressing the Opioid Epidemic through Access to Comprehensive Care

February 21, 2017

America is facing a public health crisis. Since 1999, the Centers for Disease Control and Prevention (CDC) estimates that the number of overdose deaths involving opioids (prescription opioids and heroin) quadrupled. An estimated 91 Americans die each day from opioid-related overdoses.

How did we get here?

A growing body of experts points to the overprescribing practices of prescription opioids that have led to misuse and abuse by many Americans. CDC data estimates that the number of prescriptions for opioids written in the United States has skyrocketed over the past 25 years – from around 76 million in 1991 to nearly 207 million in 2013.

A national solution to combat the epidemic is complex, and requires action and cooperation across the health care ecosystem - from providers, payers, and federal regulators – to enable a system that supports evidence-based care through addiction prevention and access to treatment.

Anthem is committed to helping its affiliated health plans combat the epidemic through new initiatives aimed to double the number of consumers who receive behavioral health services as part of medication-assisted therapy for opioid addiction. To address the continued overuse of opioid prescriptions, Anthem-affiliated health plans aim to reduce the amount of opioids dispensed by their members by 30 percent from historic peak levels by the end of 2019.

What have we learned?

For the last year, a dedicated group of Anthem medical directors, nurses, pharmacists, care managers and benefits experts have worked closely to re-examine policies and provide new insights into the role of payers to help support access to comprehensive treatment. 

The results from Anthem’s internal research of member claims with medical and pharmacy benefits identified treatment gaps left in current health plans, showing that members are not getting the best combination of behavioral health and drug therapy to combat addiction. Results showed that of those members who received buprenorphine products for MAT treatment, only about 16 to 19 percent of the members taking the medications for opioid use disorder also were getting the recommended in-person counseling.

What will we do now?

To help prevent opioid misuse and abuse before it starts, all Anthem-affiliated individual, employer, and government-sponsored health plans have begun implementing quantity limits on short and long-acting opioids.

As part of our goal to increase access to comprehensive treatment, three Anthem-affiliated health plans recently introduced standardized MAT coding for providers certified to support MAT treatment (psychiatrists and non-psychiatrist MDs) to help maximize reimbursements and streamline the reimbursement process for subsequent visits. Additionally, we are working to connect non-psychiatrist MDs with behavioral health support to systemize counseling for members also receiving drug therapy. All Anthem-affiliated health plan states will be able to utilize these practices by early 2018.

To further support access to MAT treatment, our health plan affiliates have removed the prior authorization for oral buprenorphine that was intended to help ensure clinically appropriate use, including that the member was enrolled in comprehensive counseling services.

As more research is conducted and new evidence is discovered, Anthem will continue to evaluate its programs and policies on an ongoing basis to support access to comprehensive treatment for addiction. We’ll continue to collaborate across the health care ecosystem to tackle this complex issue and help to ensure our members lead their healthiest lives. 

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