Kentucky opioid program drops dispensing by 50%

December 2, 2017

Howard Shaps, MD, senior medical director, WellCare of Kentucky, shares details about the Medicaid insurers’ pilot program designed to fight the opioid epidemic.

President Trump recently declared the U.S. opioid epidemic a national public health emergency and is calling on “mobilization of government, local communities, and private organizations” to do their part.

ShapsAs states continue to grapple with the epidemic, the CDC is encouraging them to put strategies into practice that prevent high-risk prescribing and improve treatment for opioid disorders.  Some states are beginning to see early returns on pilot programs focused on closing gaps in the system that may be contributing to unchecked access.

Kentucky is one of them. The state, which ranks third among all states in rates of death due to drug overdose, completed a six-month pilot program developed by WellCare, a Medicaid managed care provider in Kentucky. The goal of the program is to address the misuse and abuse of opioids while providing support to members most at risk.

Pharmacy shopping has been linked to a higher risk of opioid overdose, according to a study in The Journal of Pain.

Howard Shaps, MD, senior medical director, WellCare of Kentucky, talked to Managed Healthcare Executive (MHE) about the program, how it got started, and the startling results.  

MHE: Describe the pilot program.

Shaps: Beginning in December 2016, WellCare initiated a pharmacy management program to curb opioid misuse and abuse in the state of Kentucky. WellCare identified approximately 1,300 members at risk based on certain criteria including prescription dispensing, prescription refills, provider utilization, and emergency department utilization. Members were then connected to one pharmacy, one healthcare provider, and a care manager with specialized training and experience in substance abuse treatment. Care managers also help connect members to needed physical, behavioral, pharmacy, and social services.

Over the next year, WellCare will integrate the best practices of this initiative into current programs across its Medicaid markets.

MHE: What spurred the initiation of the program?

Shaps: The opioid epidemic was recently declared a public health emergency. The number of prescription opioids sold in the United States has quadrupled since 1999, and Kentucky ranks third among all states in rates of death due to drug overdose. In 2016, fatal overdoses due to opioids totaled 1,404 in Kentucky, a 7.4% increase from 2015.

MHE: What advice do you have for healthcare executives when it comes to this type of program?

Shaps: WellCare’s pharmacy management program is just one solution to address the opioid epidemic. Tackling the problem requires multiple approaches including preventing the misuse and abuse of opioids; intervening when members are at risk; supporting them with innovative treatments; collaborating with providers and encouraging appropriate prescribing; and connecting members to needed programs and social services to help them address social or economic barriers that go beyond healthcare.