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Addressing the Opioid Public Health Emergency in Oklahoma

According to the Centers for Disease Control and Prevention (CDC) Learn more about third-party links, on average, 115 people in the U.S. die each day from an opioid overdose. Many of these deaths involve prescription opioids, and more than 1,000 people are treated in emergency rooms daily for misusing these drugs.

Many of our members have felt the impact of the opioid crisis in their lives and communities. Blue Cross and Blue Shield of Oklahoma (BCBSOK) cares about the health and well-being of our 800,000 members, and we take this crisis and our role in addressing it seriously.

BCBSOK believes the greatest impact comes from helping members with the proper use and disposal of prescription opioid medication. We do this by building on our relationships with members, care providers and pharmacists. We’re also creating new partnerships to address the opioid crisis in the communities where our members live, work and play.

The opioid crisis is a complex issue. It will take the constant, collaborative effort of health providers, insurers, communities, members and all levels of government working together to develop solutions that can be started in towns nationwide.

Addressing the Public Health Emergency

By working with our health care partners and members in Oklahoma, we aim to:

Identify - Use data to identify members who may be at risk of opioid addiction and abuse.
Partner to Prevent - Work with doctors, other health care professionals, and community partners (including first responders and government health agencies) to prevent or reduce the risk of addiction and abuse.
Coordinate Care - Improve the coordination of care for our members in their battle with opioid dependence.
Educate - Conduct ongoing education and outreach about the opioid crisis. This includes treatment options, local support organizations and providers that individuals can turn to for themselves, family and friends.

Leveraging Data to Address the Opioid Crisis

We’re expanding our use of data and analytics to identify members who may be in the early stages of opioid addiction. The BCBSOK Controlled Substance Integration (CSI) program brings pharmacists, doctors, special investigations staff, behavioral health specialists and case managers together to identify causes that may lead to drug abuse and help improve member health and wellness.

The CSI member program builds upon BCBSOK’s Controlled Drug Substance program, in which members are identified based on factors that may affect patient safety or when they require additional intervention. Using a multidisciplinary approach, identified members undergo a comprehensive evaluation and a plan of action is executed.

The CSI provider program analyzes prescribing data and informs providers if members are using multiple prescribers and/or pharmacies for controlled substances. When we monitor providers after engaging them with this approach, we see an average 15mg reduction in morphine equivalent daily dose per patient.

Ensuring Safe and Effective Prescription Opioid Use

The next step we’re taking in our overall opioid strategy is starting new safety checks at the point of sale to support safe and effective use of prescription opioids.

On August 1, BCBSOK launched the Appropriate Use of Opioids program, to encourage the proper use of opioids and advocate for patient safety. The program’s safety checks address the acceptable quantity and medication dose, as well as number of sources that may issue medication, as recommended by the CDC Learn more about third-party links and other nationally recognized guidelines.

To avoid unnecessary disruption in current approved drug therapy, the Appropriate Use of Opioids program will use a phased approach over the next several months to implement these point-of-sale safety checks on opioid prescriptions, across our membership*. The program’s safety checks will be in full effect by April 1, 2019.

Members who may have opioid prescriptions that are at or above the program’s established safety requirements will be identified at the point of sale, and the pharmacist will receive a notification of the steps to take before the full quantity as prescribed can be dispensed under the member’s benefits. These safety checks are in addition to current drug dispensing limits.

The safety checks in the Appropriate Use of Opioids program are put in place to lower the chance of opioid-related dangers like overdose and death.

* The Appropriate Use of Opioids program affects employer group and individual plan business, and will not impact Medicaid or Medicare plans, at this time.

Caring for Our Members

We continue to explore ways to partner with behavioral health and clinical experts to improve access to care, avoid delays in therapy and ensure members stay current with treatments. Additionally, we work closely with our pharmacy benefit manager, Prime Therapeutics, to assess our pharmacy offerings to ensure we’re keeping health care safe, cost-effective and accessible for our members.

Members suffering from opioid use disorder may benefit from Medication-Assisted Treatment. BCBSOK removed the requirement for providers to get prior authorization when prescribing medications that help relieve the withdrawal symptoms and psychological cravings for opioids.

Blue Distinction® Centers for Substance Use Treatment and Recovery

Across the industry, there isn’t a standard way to measure addiction treatment centers. This often results in substandard, and sometimes even harmful care which slows recovery and burdens families. That’s why it’s so important to look at how we care for those struggling with opioid use disorder and make sure our members can get quality, comprehensive care.

In July 2018, BCBSOK, all 35 other Blue Cross and Blue Shield Plans and the Blue Cross and Blue Shield Association (BCBSA) committed to launch Blue Distinction Centers for Substance Use Treatment and Recovery Learn more about third-party links and set up a nationwide hotline by January 2020.

Over the next few months, BCBSOK will work with BCBSA to review and find spots for Blue Distinction Centers in Oklahoma. Once in place, these 2 assets will make sure members have access to the best clinical care and evidence-based treatment to make effective, long-term recovery a reality.

Partnering to Prevent Addiction and Abuse

BCBSOK promotes National Prescription Drug Takeback Day Learn more about third-party links in our communities twice a year – part of a nationwide effort sponsored by the U.S. Drug Enforcement Administration. Safe medication disposal is one of the ways to make sure medications are not accidently used or intentionally misused by someone else.

The next National Drug Takeback day is October 27, 2018.

Opioid Policy in Oklahoma

BCBSOK continues to work with policymakers at the state and local level to find solutions to the opioid crisis as well as advocate on behalf of our members throughout Oklahoma suffering from opioid use disorder.

Last year, Oklahoma received funding through the 21st Century Cures Act to focus on health surveillance, responsible pain management, improving access to treatment services, targeting availability and distribution of overdose-reversing drugs, and supporting research.

Additionally, Oklahoma was the recipient of a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand access to medication-assisted treatment services for people with opioid use disorder and awarded CDC funding for Prevention for States program/Data Driven Prevention Initiative and Enhanced State Opioid Overdose Surveillance (ESOOS).

The Oklahoma Prescription Monitoring Program requires prescribers to perform initial database check for new patients prior to prescribing one of the following: opiates, synthetic opiates, semi-synthetic opiates, benzodiazepine, or carisoprodol (exclusions for Hospice or end-of-life, or patients residing in nursing facility). Dispensers must submit prescription dispensing information within 5 minutes of dispensing a scheduled narcotic.

Supporting Research to Understand the Opioid Crisis

BCBSOK works closely with the BCBSA Learn more about third-party links in its efforts to address the opioid crisis across the country.

To understand how the opioid crisis affects our members, BCBSOK worked with the BCBSA to develop the The Opioid Epidemic in America: An Update Learn more about third-party links which was released in July 2018. Researchers looked at a 5-year study of medical claims BCBSA and found a 29% drop in opioid prescriptions.

Third-Party Resources