Prescription drugs are an essential part of effective health care. But misuse, abuse, addiction and overdose can transform some medicines, notably opioids, into a dangerous public health concern. As stated by the CDC, "Each day, 44 people in the United States die from overdose of prescription painkillers. People who take prescription painkillers can become addicted with just one prescription. Once addicted, it can be hard to stop. In 2013, nearly two million Americans abused prescription painkillers. Each day, almost 7,000 people are treated in emergency departments for using these drugs in a manner other than as directed."1
Prime’s director of health outcomes, Pat Gleason, PharmD, FCCP, BCPS, collaborated with a diverse group of experts to author a report outlining an evidence-based response to the nation’s opioid epidemic. The Prescription Opioid Epidemic: An Evidence-Based Approach was presented at a recent event hosted by The Clinton Foundation and Johns Hopkins Bloomberg School of Public Health. Dr. Gleason was lead author on a chapter featuring specific recommendations for how pharmacies and pharmacy benefit managers (PBMs) can help address the opioid epidemic, including:
- Inform and support evaluation research. Prescriber letter interventions have been shown to decrease controlled substance claims. But greater research is needed to evaluate clinical and economic impact, and inform program value.
- Engage in consensus process to identify evidence-based criteria for using PBM and pharmacy claims data to identify people at high risk for abuse and in need of treatment. Current criteria need further validation and refinement to reduce false positive and negative identification. Bringing together experts in the field through a consensus process can help to accomplish this.
- Expand access to state-run prescription drug monitoring programs (PDMPs). Allowing managed care plans and PBMs access to PDMP program information can help them to identify a more complete claims history for covered members. This information can inform more effective interventions.
- Improve management and oversight of individuals who use controlled substances. Managed care plans and PBMs are uniquely positioned to collect data and take action. If the Centers for Medicare & Medicaid Services (CMS) offered incentives to implement and evaluate innovative, targeted medicine management strategies, the impact could be significant.
- Support restricted recipient (lock-in) programs. There has been demonstrated success of lock-in programs with Medicaid beneficiaries. These programs limit an individual to receiving their controlled substance prescriptions to one prescriber and pharmacy for insurance coverage. The federal government should amend Medicare Part D to allow restricted recipient lock-in programs for prescribers and pharmacies.
- Support take-back programs. Pharmacies are a convenient place for people to properly dispose of controlled substances.
- Improve monitoring of pharmacies, prescribers and beneficiaries. All PBMs should provide a list of suspicious pharmacies, prescribers and beneficiaries to the National Integrity Medicare Drugs Integrity Contractor.
- Incentivize electronic prescribing. E-prescribing for controlled substances can help to reduce fraud and forgery.
1. CDC. (n.d.). Understanding the epidemic: when the prescription becomes the problem. Retrieved from http://www.cdc.gov/drugoverdose/epidemic/index.html