Blue Cross of Idaho Addresses State s Opioid Issue BY THE NUMBERS - Opioid Management page 3 THE PROBLEM - How Preventing Pain Hurt Us page 4 THE SOLUTIONS - Idaho State Board Of Pharmacy Prescription Monitoring Program page 5 SUCCESS SO FAR - Savings costs, lives page 6 THE FUTURE - What s Next page 6
Focusing on Opioids in Idaho Opiate use and misuse is a national public health emergency. Easy access to highly addictive pain medications created a crisis we are all paying for. In fact, more than $78 billion is spent each year on medical and substance abuse treatment and criminal justice related to opioids. Opiate abuse in Idaho is mild when compared to national statistics. According to the National Institute of Health in 2016, Idaho had 119 opioid-related deaths. That equates to a rate of 7.4 deaths per 100,000 persons. The national rate is 13.3. Idaho ranks number 16, with West Virginia the highest at 52, and Nebraska as the lowest with 6.4. However, opioid-related deaths in Idaho increased 24 percent from 2015 to 2016. State leaders, healthcare providers and Blue Cross of Idaho are taking steps to protect Idahoans. The fallout from opioid abuse has ravaged families, communities and states, said Dr. Daniel Meltzer, Senior Vice President and Chief Medical Officer for Blue Cross of Idaho. Idaho has lower numbers than the national average, but even one opioid-related death is too many. That s why Blue Cross of Idaho is proud to take the necessary steps to protect our families, friends and neighbors. One of the larger challenges is distinguishing between legitimate medical need and at-risk opioid use. In partnering with our pharmacy benefits administrator, CVS, the Idaho State Board of Pharmacy and healthcare providers, we ve found ways to lower risks without compromising care. Since 2015, we ve seen a nearly 45 percent reduction in new opioid prescription users and a 61 percent reduction in the number of prescriptions written. In 2016, there were 119 opioid-related overdose deaths in Idaho a rate of 7.4 deaths per 100,000 persons. Number of Opioid-Related Overdose Deaths in Idaho Number of Deaths 140 120 100 80 60 Total Heroin Synthetic Opioids Rx Opioids 119 77 40 20 25 20 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2 Source: CDC WONDER
BY THE NUMBERS OPIOID MANAGEMENT National The U.S. Department of Health and Human Services reported that in 2015, 12.5 million Americans reported having misused opioids. On average 1,100 adolescents start to misuse prescription pain relievers each day. More than 1/3 of those misusing prescription opioids get them through a prescription or healthcare provider. Substance abusers have $15,500 in extra medical costs each year compared to non-abusers. Idaho Idaho-opioid related deaths have increased 24 percent from 2015 to 2016. Pharmacy-Related Opioids 86 deaths in 2016 42% increase from 2015 Heroin 24 deaths in 2016 53% increase from 2015 466 Idahoans died of opioid related overdoses between 2012-2016. Other/Unspecified Narcotics 8 deaths in 2016 National Idaho Opioid-related death rate per 100,000 13.3 7.4 True numbers of opioid related deaths are likely higher due to under reporting 3
THE PROBLEM HOW PREVENTING PAIN HURT US In healthcare, vital signs indicate a patient s health and well-being. Vital signs include body temperature, heart rate, breathing rate and blood pressure. In the mid 1990 s, pain was added as a fifth vital sign. The Substance Abuse and Mental Health Services Administration reports that on average, 1,100 adolescents begin misusing prescription pain relievers each day. By the 2000s, more medications were developed to treat pain. Patients asked for these drugs and doctors prescribed them. Opioids were prescribed so often that they could be found in nearly every home. By 2012, opioid overdose was common in hospitals around the United States. Opioid addiction reached the highest levels ever in 2016. According to the Centers for Disease Control and Prevention (CDC), the number of opioids prescribed nationwide is about three times higher than in 1999. U.S. opioid addiction reached the highest levels ever in 2016. 4
THE SOLUTIONS IDAHO STATE BOARD OF PHARMACY PRESCRIPTION MONITORING PROGRAM In 1997, the Idaho State Board of Pharmacy (BOP) created a prescription monitoring program (PMP). A PMP is a statewide electronic database that collects data on prescription drugs. This database tracks how often controlled substances are dispensed and filled. This is a valuable tool to help stop misuse and abuse. In 2017, the BOP began requiring pharmacists and prescribers to register and access the database. They also began combining its PMP with electronic health records. Prescribers can now more quickly look up patients past and current controlled substance use. BLUE CROSS OF IDAHO S NEW OPIOID MANAGEMENT STRATEGY Blue Cross of Idaho s primary strategy to lessen opioid addiction is by limiting availability. This strategy includes components that align with the Centers for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain. We also track prescribing and use patterns as a secondary means of prevention. 1. Limiting the number of days an opioid is prescribed. Opioid naïve members are those who, according to their claims, haven t used the drug before. In drugs like morphine, for example, we limit the number of days supply for new and acute prescriptions for opioid naïve members. A prescriber can put in a preapproval request if more than seven days is needed. 2. Limiting the strength of prescribed opioids to opioid naïve members. A milligram morphine equivalent (MME) is a calculation that combines the opioid type, the number of days the drug will be taken, and the total daily dose. MME helps ensure the patient is not at risk of overdosing or getting addicted. For opioid naïve members, opioid prescriptions that exceed a dose of 90 MME/day require preapproval. A prescriber can request larger doses before prescribing. 3. Require Step Therapy Prescribers must first use opioids that are immediate-release or fast acting before prescribing extended-release or long-lasting. Often, immediate-release drugs cost less but are just as effective. 5
SUCCESS SO FAR SAVINGS COSTS, LIVES From 2015 to April 2018, Blue Cross of Idaho saw a decrease in the number of members opioid prescriptions. More closely setting access limits has led to improvements. In just two-and-a-half years, the net cost of such drugs dropped 66 percent. The savings benefit members, employer groups and taxpayers. Our objective is to save lives, not limit access to needed medications. By limiting the number of days an opioid is prescribed, limiting the strength of prescribed opioids and requiring step-therapy, we ve seen a 45-percent reduction in opioid prescription users since 2015, said Dr. Daniel Meltzer. DECREASE OF OPIOID PRESCRIPTIONS, 2015-2018 Time Period # Rx % Change Unique Utilizers % Change Gross Cost % Change Net Cost % Change YTD 2018 75,200-61.15% 30,156-44.93% $2,811,869.00-67.88% $2,191,440.00-66.33% 2017 193,566-18.35% 54,763-16.95% $8,754,341.89-24.81% $6,509,356.51-26.14% 2016 237,080-9.39% 65,936-7.30% $11,642,754.37-8.68% $8,812,889.34-10.65% 2015 261,663 71,131 $12,749,673.62 $9,863,650.70 THE FUTURE WHAT S NEXT? Blue Cross of Idaho is working to remove barriers to care, educate about drug abuse and save lives. We recently removed former financial barriers to access naloxone, a life-saving drug designed to rapidly reverse opioid overdose. This will make the drug more readily available and save more lives. Our Behavioral Health team works to provide intensive transition of care to help members who present with opioid addiction. This means they will receive improved care upon release from in-patient detox/rehab and connects them with our Case Management team for support. As October is National Substance Abuse Prevention Month, we are taking the opportunity to educate our members and social media followers on the signs of addiction and how to avoid opioid abuse. On October 27, we will host a prescription drug disposal event in honor of the Drug Enforcement Administration s National Prescription Drug Take Back Day. People can safely and conveniently dispose of unused prescriptions on our Meridian, Idaho campus. Volunteers will be on hand to talk about how to prevent drug addiction and overdose. The Blue Cross Blue Shield Association (BCBSA) is working to advance the safety and effectiveness of treatment for opioid use disorder. The BCBSA will launch a Blue Distinction Centers for Substance Use Treatment and Recovery designation to ensure members have access to the best evidence-based treatment for substance use disorder. A national hotline will be created so people can have recovery support. Both resources are expected to launch in 2020. Members can call 208-387-6924 or 800-627-6655 with questions on opioid addiction. 6
SOURCES Division of Public Health Statistics, Drug-Induced Deaths: Idaho Residents, 2016 Summary Idaho Department of Health and Welfare., August 2017. Florence, C S, et al. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Advances in Pediatrics., U.S. National Library of Medicine, Oct. 2016. National Institute on Drug Abuse. Idaho Opioid Summary. NIDA, 28 Feb. 2018. Substance Abuse and Mental Health Services Administration, and Center for Behavioral Health Statistics. Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. GenTwenty, The Mercury News, 2015. 7
2018 by Blue Cross of Idaho, an Independent Licensee of the Blue Cross and Blue Shield Association