BCBS program drastically reduces painkiller scripts

April 24, 2014

An 18-month statewide program to decrease painkiller prescriptions and lower addiction risks resulted in 6.6 million fewer doses dispensed, Blue Cross Blue Shield of Massachusetts recently announced.

An 18-month statewide program to decrease painkiller prescriptions and lower addiction risks resulted in 6.6 million fewer doses dispensed, Blue Cross Blue Shield of Massachusetts recently announced.

BCSC implemented new safety measures in 2012 after its own review showed that more than 30,000 of its members received prescriptions for powerful painkillers such as Vicodin and Percocet lasting longer than 30 days, which many experts believe increases the risk of addiction.

The program’s goal was to improve safety and quality for BCBS members, decrease painkiller prescriptions, lower addiction risks, and prevent pills from being diverted.

"Our program is about preventing harm by making sure our members receive the highest quality care for pain, while reducing the risks that come with such treatments," said John A. Fallon, senior vice president and chief physician executive for BCBS Massachusetts. "The results are encouraging and show that, among other things, health plans can play a meaningful role in helping to prevent prescription pain medication addiction."

The new measures resulted in a 20% decrease in claims for short-acting opioid painkillers such as Vicodin and Percocet, 50% decrease in claims for long-acting opioids such as OxyContin, and more than 90% of patients prescribed greater than the recommended daily dose for acetaminophen had their prescriptions adjusted by the prescriber.

 

"The goal of treating pain is to relieve suffering and not to create more problems for patients," said Edgar Ross, medical director for pain management at Brigham and Women's Hospital. "I was pleased to help in designing this evidence-based program, and I'm happy to see that it is improving quality and safety without creating barriers to care."

The new safety measures include requiring patients to receive prior authorization from BCBS for more than 30 days of painkillers such as Percocet within a two-month period. Patients can fill a 15-day prescription and one additional 15-day supply before the insurer intervenes. Before any additional painkillers are authorized, the patient must undergo an addiction-risk assessment and agree to a treatment plan.