Plan data can alert physicians to pain medication abuse

Key Points

PAIN MEDICATIONS for chronic conditions are making it on the list of most frequently used drugs for some health plans. And as utilization increases, so does the potential for abuse. The number of Americans seeking treatment for addiction to prescription pain medications increased 400% just over the last decade.

That should be warning for payers and other stakeholders to jump-start programs that manage opioid use, such as fill monitoring and medication use agreements signed by the patient and physician.

"Oxycontin and hydrocodone are replacing cocaine and heroin as the most popular street drugs," says Martin Burruano, director, pharmacy services for Independent Health in Buffalo, N.Y.

"Physicians are not always aware of the utilization of pain medications by their patients," says Nivedita Kohli, clinical pharmacist for Independent Health.

Physician tools include a written medication contract asking patients to voluntarily agree to obtain pain medications from only one source and to be available for random urine screenings. Burruano says that the strategy has been able to reduce the use of the combination drug by 8% since 2007.

Independent Health has a few other best practices: placing longer-acting pain medications on tier two of its formulary to encourage use; prior authorization; a registry online for physicians to review their patients' opioid use; and sponsorship of a pain medication education course for primary care physicians, pharmacists and mid-level practitioners. The first course covered prescribing safety measures, behavioral health issues related to self-care and legal implications of prescribing opiates.

The health plan also participated in the Drug Enforcement Agency (DEA) Prescription Drug Take-Back program and successfully hauled off 25,000 units of opioids.

Aetna Pharmacy Management, a pharmacy benefits manager (PBM), kicked off Aetna Rx Check Patient Safety nearly a year ago and added enhancements in October. The program analyzes prescription drug claims and identifies individuals who are being treated for opioid addiction with buprenorphine, but continue to receive prescriptions for pain medications such as Oxycontin. Taking the two drugs at the same time may cause a dangerous interaction.

A rapid retrospective claims engine analyzes members' prescription drug claims and identifies opportunities to improve care and prevent misuse, according to Robert Gregory, head of clinical programs for the PBM. Once a problem is detected, Aetna Rx Check reaches out to physicians to alert them to a possible drug-to-drug interaction, duplication in drug therapy or other serious issues. Aetna invites prescribers to ask questions about appropriate prescribing.

Its controlled substance use program separately identifies patients who are taking multiple pain medications and using multiple pharmacies and prescribers.

Gregory says anecdotally that the program has reduced the number of members identified with simultaneous use of pain medications.

"We want to ensure that we don't place barriers in front of members seeking addiction therapy, while also preventing ongoing abuse," he says.