Health plans can play a crucial role in reducing high-risk, emergency room opioid prescriptions, according to a recently published Harvard study designed to examine Blue Shield of California’s efforts to promote safe opioid prescribing.
The study further suggests that a health plan’s efforts to manage and set limits on opioid prescriptions alone is not enough to significantly reduce its use but should be just one component in a comprehensive and ongoing approach in the effort to halt the opioid epidemic.
“Creating systemic change with lower rates of safer prescribing likely requires a series of complementary policies implemented over a sustained period of time,” concludes the study.
The study was conducted by researchers from the Harvard School of Public Health and Medical School, in conjunction with the California Health Care Foundation to formally evaluate aspects of Blue Shield of California’s Narcotic Safety Initiative (NSI). The study is one of the few rigorous pieces of research measuring the impact of opioid-related initiatives and policies, and uses a control population comparison.
Blue Shield launched NSI in 2015 to address the crisis in opioid addiction and death by overdose. According to the Centers for Disease Control, more than 42,000 opioid overdose deaths occurred in 2016 alone.
Blue Shield recognized that creating a process to eliminate opioid over-prescription was key to slowing the crisis. Its initial efforts targeted ER prescriptions of Oxycontin, which was the most commonly prescribed ER opioid among Blue Shield members, and most frequently abused opioid in the U.S.
Since it launched NSI, the overall consumption of opioids among Blue Shield members with non-cancer pain has fallen by 42 percent. The plan’s goal was to reduce inappropriate prescribing and overuse of opioid narcotic medication use among its health-plan participants by half by the end of this year.
In addition to prudent opioid prescribing and proactive management, NSI also included plans to increase patient access to alternative pain management programs, as well as addiction and substance abuse treatments. Blue Shield also participated in national, state and local task forces, and collaborated with the California Department of Justice to educate its providers about California's prescription drug monitoring platform known as the CURES database.
The Harvard study found that one of NSI’s specific policies called prior authorization—the administrative process that requires prescribers to submit a patient’s prescription history and intended use of opioids for review by the health plan—resulted in a “significant 36 percent relative reduction in new ER opioid starts and an 11 percent relative reduction in monthly rates of ER opioid prescribing.”
Researchers were concerned that the administrative hurdle of prior authorization would lead providers to simply prescribe another type of ER opioid, but they didn’t observe such a change. Instead, clinicians were more likely to prescribe a shorter-acting opioid. There was also concern about other unintended consequences of enacting prescription restrictions—causing the health plan’s opioid users to disenroll from the plan. But the study did not discover any significant changes in disenrollment.
The study also notes that other serious unintended consequences of opioid prescription restrictions have yet to be measured, including the extent to which prescription opioid users seek illicit drugs, or how often pain goes untreated. But the study encourages ongoing research to further determine such impacts.