Payers strategize to manage opioid use

How managed care organizations manage opioid utilization and some of the limitations to those management strategies was a hot topic at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, in Denver.

LenzKimberly Lenz, PharmD, clinical pharmacy manager, University of Massachusetts Medical School and Tyson Thompson, PharmD, clinical consultant pharmacist, University of Massachusetts Medical School, spent time discussing recommendations from the AMCP Addiction Treatment Advisory Group during their March 28 session, “Tackling the Opioid Epidemic and Addiction Treatment: A Managed Care Approach.”

Relatively common payer strategies to address opioid utilization include prior authorization on certain formulations/products, quantity limits, dose limits, controlled substance “lock-in” programs, and restrictions on the use of multiple short-acting or multiple long-acting opioids, Thompson told Managed Healthcare Executive.

ThompsonMost traditional utilization management strategies have limitations, some more significant than others, he said. “If strategies are overly restrictive, access to appropriate pain management can be impeded.”

Many management strategies used to promote safe opioid use can simply be skirted if the patient pays out of pocket, said Thompson.

“There are also instances where a plan may try to manage a specific product that is popular for recreational use, and the utilization may simply shift to a different formulation or product, having minimal impact on reducing recreational use of that opioid,” he said. “There are plenty of examples of limitations of utilization management strategies, so it is important for the payer to be cognizant of these and at times, be more creative in its approach.”

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