Policy on the Epidemic: How Payer Programs are Moving Strategically to Act on Opioids
WellCare Pharmacy Management Pilot Program Reduces Opioid Dispensing by 50 Percent Among At-Risk Populations Company has implemented program solutions across Medicaid markets to help prevent opioid misuse, abuse and addiction As the nation faces a growing opioid crisis, WellCare Health Plans, Inc., a leading provider of Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, saw a 50 percent reduction in opioid dispensing among members participating in a pharmacy management program in the company’s Kentucky market. According to the Centers for Disease Control and Prevention (CDC), the amount of prescription opioids sold in the United States has quadrupled since 1999, and 91 Americans die from an opioid overdose every day. These numbers are particularly alarming in the state of Kentucky, which according to the CDC, ranks third among all states in opioid addiction. The Kentucky Office of Drug Control Policy reports fatal overdoses due to opioids totaled 1,404 in 2016, a 7.4 percent increase from 2015. In response, WellCare leveraged its pharmacy management pilot program to curb opioid misuse and abuse in Kentucky. Beginning in December 2016, WellCare identified approximately 1,300 members at risk for opioid misuse or abuse based on risk criteria including prescription dispensing, prescription refills, pharmacy use and emergency department utilization. Members were then connected to one pharmacy, one healthcare provider and a care manager with specialized training and experience in substance abuse treatment. Care managers also helped connect members to needed physical, behavioral, pharmacy and social services. In addition to the 50 percent reduction in opioid dispensing, results for the first six months of the program included a 35 percent decrease in the dispensing of cyclobenzaprines, a common muscle relaxant, and a 30 percent reduction in the dispensing of benzodiazepines, a class of psychoactive drugs. “Tackling the opioid epidemic requires multiple approaches,” said Dr. Howard Shaps, senior medical director, WellCare of Kentucky. “It includes preventing the misuse and abuse of opioids; intervening when our members are at risk; supporting them with innovative treatments; collaborating with providers and encouraging appropriate prescribing; and connecting members to needed programs and social services to help them address social or economic barriers that go beyond healthcare.” “As a leading provider of managed care services, WellCare has a responsibility to help curb the opioid epidemic, not only in Kentucky, but across the country,” said Dr. Mark Leenay, WellCare’s senior vice president and chief medical officer. “Over the next year, WellCare will integrate the best practices of this initiative into current programs across our Medicaid markets.