Christian Brothers Services along with Express Scripts is leading the fight to end the opioid epidemic through partnership
Each day …
▶ 90 people lose their lives due to opioid overdose;
▶ more than 1,000 people are treated in emergency
rooms for misusing prescription opioids;
▶ families from all walks of life are losing loved ones
The undeniable truth—opioid addiction is so prevalent that these facts are nearly part of daily reporting. Yet, we continue to see the toll it takes on the faces of our family and friends. It’s not cocaine or the hard-hitting image of what we think a drug addict looks like–it’s the mom across the street who started taking painkillers for a bad back or the teenage athlete who started popping pills to stay in the game despite a sprained ankle, or the baby sitter who received a 30-day supply of hydrocodone for having a tooth extracted. Seemingly legitimate, their addiction starts with a little pill innocently prescribed by their doctor.
With more than 2 million people addicted to prescription narcotics, it is one of the largest public threats facing the nation. Recognizing the crisis and the need for a call to action, Christian Brothers Services (CBS) is working in partnership with its prescription benefit manager, Express Scripts, Inc. (ESI), through an unprecedented program set to curb the misuse of opioids through both prescriber and patient outreach and education.
“We have the overall wellness and safety of our members in mind when we make decisions such as these,” said John Airola, managing director, Christian Brothers Health Benefit Services. “It may not be popular and, at times, even frustrating for our members, but it’s worthwhile if we can prevent our members from this crisis which has caused the death of more Americans under the age of 50 than any other cause.”
As an industry leader, ESI made a bold call last summer, by introducing its Advanced Opioid Management Program, which addresses both prescriber and patient issues in an effort to help fight the opioid epidemic. ESI is the first in the industry to address potential behavior and safety gaps at each level including the patient, the pharmacy and the doctor’s office.
The program is a comprehensive solution that reduces excessive and inappropriate opioid prescribing, particularly for those taking an opioid for the first time and puts clients in greater compliance with guidelines recommended by the Centers for Disease Control and Prevention (CDC). Early results are already encouraging, pointing to a decline in opioid use. In the first 90 days of the program’s inception, there has been a nearly 60 percent reduction in the average days’ supply for patients receiving an opioid prescription for the first time. On average, a patient’s prescription has decreased from an 18.6-day supply per person before the launch of the program to a 7.5-day supply per person.
In addition, since the start of the program, 95.9 percent of patients prescribed an opioid for the first time started with a seven-day supply or less. The ultimate goal is to stop abuse before it starts, putting an end to over prescribing, over dispensing and unsafe use of pain medications. Educating patients, physicians and pharmacists is at the core of the program. The Advanced Opioid Management Program addresses the many concerns
in the care continuum and offers solutions ranging from counseling on the proper use of the medication and its safe disposal for patients, to tools for physicians at the point of care and safety checks for dispensing pharmacies.
According to ESI, because the opioid epidemic is such a complex issue, effecting change requires addressing all parties that influence opioid decisions. Through its data analytics, specialized care model, fraud, waste and abuse management capabilities and application of behavioral
science, ESI is uniquely positioned to engage prescribers, mobilize payers, and protect patients to address the national epidemic comprehensively.
Less than a year into the program, ESI was awarded the Pharmacy Benefit Management Institute’s (PBMI) Excellence Award in the Opioid Management Strategy Category.
“We are pleased to present Express Scripts with this award for their Advanced Opioid Management solution which successfully influences behavior at each touchpoint of the drug therapy continuum helping patients appropriately utilize these highly addictive medications,” said Jane Lutz,
executive director, PBMI. “The strategy behind this program blends prescriber support, patient outreach/education, and point-of-sale management for effective results.”
Research shows that after just 10 days on a prescription opioid, one in five people become long-term users. From the time a patient is prescribed medication, safeguards are put in place, allowing patients to receive the medication they need while preventing unnecessary refills that could put patients at risk of significant harm. Part of the service is to educate patients that opioids, while a very effective tool for managing pain, are also very powerful drugs that also can cause side effects and possible dependence.
As an added benefit and at no cost to them, patients are offered assistance and tips for maintaining healthy habits for taking medicine as prescribed.
“This has become quite an epidemic of sorts and we need to do our part to help protect our members from potential abuse and addiction these types of medications can cause,” said Airola.
Through the program, many checks and balances are apparent. Neuroscience Therapeutic Resource Center (TRC) pharmacists provide proactive counseling on safe opioid use during calls with first-time opioid patients; program members send thousands of educational letters and safe disposal bags to patients who received an opioid prescription, and prescribers are notified when a patient has accumulated an unsafe amount of opioid medication.
In addition, with a focus on safety, a point-of-sale component targets the use of fentanyl, an incredibly potent drug linked to a rise in overdose deaths. Requirements have been added to the coverage approval to tighten the criteria for fentanyl products. Additionally, a new Drug Quantity
Management (DQM) for fentanyl patches has been created for a complete and comprehensive DQM solution for opioids.
Physician care alerts are also in place to recommend the co-prescription of naloxone, a drug used for overdose reversal, for potentially high-risk members who are receiving a large number of opioid prescriptions where treatment does not appear to be coordinated. Another component of the program addresses physician education and peer comparison, including prescriber educational messaging that leverages behavioral science
and social norming based on the area of practice and peer comparison to encourage more conservative opioid prescription.
To further crack down on opioid abuse, ESI also offers an Enhanced Fraud, Waste and Abuse (FWA) Program, which provides quarterly reports that identify unusual behavior. This report identifies individuals who have received five or more claims for controlled substances from three or more
prescribers during the most recently completed calendar quarter. A known tactic for gaining access to more prescriptions, “doctor shopping,” is typically used to feed an addiction, stockpile the medication in one’s home, or divert the medication to other people on the street. The FWA monitors more than 100 different related scenarios.
Controlled prescription drugs, specifically opioids, have been linked to the largest number of overdose deaths of any illicit drug class, outpacing those for cocaine and heroin combined since 2001. In addition, the CDC estimates that the total “economic burden” of prescription opioid misuse alone in the U. S. is $78.5 billion a year, including the cost of health care, lost productivity, addiction treatment and criminal justice involvement.
ESI also recognizes that the nation’s employers are inadvertently paying for one-third of the opioid medication that ends up being misused and is ultimately damaging to their benefit plan members and their families. With the Advanced Opioid Management Program, ESI believes its
approach is more than just utilization management and is about working comprehensively to put an end to the opioid crisis.
Christian Brothers Health Benefit Services is committed to serving its members through partnerships such as those with ESI that continue to work to truly understand the needs of its members.