Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Highmark Declares 'War on Opioids' Insurer Places New Restrictions on Prescriptions for Painkillers

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Highmark Declares 'War on Opioids' Insurer Places New Restrictions on Prescriptions for Painkillers

Article excerpt

Highmark on Thursday morning declared "war on opioids," announcing new restrictions and other curbs on the prescribing of the powerful painkillers widely blamed for spurring an epidemic of overdoses.

"We have to do something about it," said Deb Rice-Johnson, president of the insurer, which spans Pennsylvania, West Virginia and Delaware and includes the Allegheny Health Network. "We have declared war on opioids."

Starting March 8, the insurer's commercial members - those insured through employer or individual plans - who aren't already receiving opioids will be limited to seven-day prescriptions for those drugs for acute pain incidents. Those members will also be limited to 14 days worth of opioids in a given month.

The insurer will also require prior authorization before it will cover long-acting opioids. It will encourage other therapies, Ms. Rice-Johnson said, including physical therapy, chiropractic care and acupuncture.

Patients who have long received opioids for chronic pain won't be subjected to any sudden cutoff, said Charles DeShazer, Highmark's senior vice president and chief medical officer. They might be weaned off.

"You can't just shut off folks in that sense, because what frequently happens is they go to heroin or fentanyl or other street drugs," Dr. DeShazer said. But some acute pain patients might never be started on opioids. "If it's pain that's an annoyance, and it's not life-threatening, and you can get through, that may be a different approach" that doesn't include opioids.

The insurer has already begun to use axialHealthcare, a Nashville, Tenn.-based contractor, to tell doctors about patients believed to be at risk of opioid abuse. Highmark began to use the company to monitor Pennsylvania patients and doctors effective Feb. 1.

The company's reports assign a score, of 1 to 100, that estimates a patient's risk for abuse. The reports also detail the risks.

Highmark executives announced the changes at a morning news conference at the Highmark Caring Place, Downtown.

Prescribing practices and inconsistent state oversight contributed to increasing numbers of Americans dependent on opioids.

The Pittsburgh Post-Gazette reported in 2016 that Highmark hired axialHealthcare to comb its data for indications of overprescribing in West Virginia, and that the insurer would discuss appropriate prescribing with doctors who recommended opioids more frequently than recommended in guidelines.

According to Highmark on Thursday, the company's work in West Virginia led to consultations with 250 doctors, a 28 percent reduction in patients getting narcotics from multiple prescribers, and a 25 percent drop in patients receiving both opioids and certain sedatives.

Ms. Rice-Johnson emphasized the families broken and the lives lost to the epidemic. …

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