Four Important Steps to Address the Opioid Crisis

Posted on Nov 10th 2017 by Florida Blue Support Team

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Declared by the Center for Disease Control to be a nationwide epidemic, the opioid crisis gripping America has become the deadliest health issue in recent history.

The numbers are staggering. Drug overdoses are now the leading cause of death for Americans under 50, killing over 64,000 people last year. That’s more than car accidents or guns—and two thirds of the deaths were from prescription opioids.

The problem is especially bad in Florida. Toxicology results determined that opioids were present at the time of death in 4,515 Floridians last year, as shown in a 2016 report from the Florida Medical Examiners Commission. Earlier this year, Governor Rick Scott signed an executive order proclaiming the opioid epidemic in Florida a statewide emergency.

Florida Blue is taking four important steps to protect both members and their families from the risk of opioid abuse and misuse.

What are Opioids?
According to the National Institute on Drug Abuse, opioids are a class of drugs that include the illegal drug heroin as well as certain prescription medications like oxycodone (including OxyContin®), hydrocodone (including Vicodin®), methadone, fentanyl, codeine, morphine and many others.

Opioid pain relievers have an important place in medicine. These drugs interact with the nervous system to control pain.

They are generally safe when taken for a short time as prescribed by a doctor.
Prescription opioids can improve the quality of life for cancer patients and others suffering from severe pain. But like many drugs, they can be misused. Regular, ongoing use—even as prescribed by a doctor—can lead to dependence.

Opioid Dependence
The number of patients diagnosed with opioid dependence has increased nearly six times over the past five years, with the American Society of Addiction Medicine reporting that two million people were battling addiction to prescription pain relievers in 2015. We know that since then the numbers have grown. 

The problem crosses all demographic boundaries. Chances are you know someone who has been affected.

Florida Blue is Taking Action: Four Important Steps to Fight Opioid Abuse

(1) Starting Jan. 1, 2018, we will no longer cover OxyContin (oxycodone HCI ER) for our non-Medicare members. Xtampza ER (oxycodone ER) will replace OxyContin as the preferred long-acting oxycodone product. Quantity limits will apply for Xtampza ER (six capsules a day).

Xtampza ER is a new oxycodone formula developed specifically to help prevent abuse of the drug. It is Federal Drug Administration approved to manage pain that requires long-term opioid treatment.

“Those who are abusing OxyContin typically try to tamper with the drug by crushing it, creating a higher and faster-acting dose that can be snorted or injected. This type of consumption can quickly lead to addiction and overdose,” said Scott McClelland, Pharm.D., vice president of commercial and specialty pharmacy at Florida Blue. “After careful review of the scientific data supporting the abuse-deterrent features of Xtampza ER, we decided to replace OxyContin on the formulary. We believe this will be an important step to addressing the opioid epidemic on behalf of our members in the state.”

Letters will be sent to existing users notifying them of the formulary changes and recommending that they follow up with their provider to discuss Xtampza as a potential alternative.
This formulary change allows for continued access to oxycodone for those who need it but in a better, abuse-deterrent formulation.

(2) We’re working to identify and manage abusive prescribers throughout the state. This effort includes partnering with our pharmacy benefits manager, Prime Therapeutics, and working closely with local and federal law enforcement agencies when prescriber data identifies potential fraudulent activity.

(3) A monitoring program has been introduced to help members safely manage their condition(s) while using opioid medications. Monitoring helps us track whether an opioid prescription is being refilled at a faster-than-normal rate. If needed, we can then communicate with providers to ensure that patients are using their medications safely.  

(4) We are requiring pre-authorization for opioid prescriptions written for more than seven days. In cases where longer-term usage is appropriate, such as cancer, we typically request that the physician writes two prescriptions-one for the first seven days, and the other for 30 days. This way, the member and provider can request a prior authorization for the 30-day prescription while the member is using the seven-day supply. This prevents medication delays.

Once the 30-day authorization is recorded in our system, the member will not have to go through the pre-authorization process again.  

Each of these programs reflects our commitment to the health and safety of our members. The opioid epidemic is a complex problem but Florida Blue is on the front lines in battling it.

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