Blue Cross takes on opioids

August 21, 2018

Blue Cross of Idaho is working to implement rules that would limit the strength of opioids doctors prescribe and how long patients stay on them in an effort to combat opioid abuse.

Blue Cross of Idaho is implementing new guidelines for the prescription of opioid painkillers, an effort to combat the rising tide of opioid addiction in the state. Blue Cross insures about 542,000 Idahoans, or about one-third of residents in the state.

The Gem State as a whole has been slower to develop a major opioid problem than some other areas of the nation, but addiction and overdose deaths have been mounting. The problem is particularly severe in eastern Idaho, the Post Register has previously reported, where the overdose death rate rivals that in states such as Indiana.

The new guidelines come in response to emerging research and updated Centers for Disease Control guidelines for the use of opioids, said Dr. Daniel Meltzer, the company’s senior vice president and chief medical officer.

“The strategy is twofold,” Meltzer said. “One, try to reduce or eliminate the number of people who are exposed to opioids. Two, provide safe and effective ways off of opioids for those who are addicted.”

The company also recently placed Naloxone, a medication that can be used to arrest an opioid overdose, to the top tier on its formulary, said Karen Smith-Hagman, vice president for clinical consultancy. That will reduce copays for the generic form of the drug. Smith-Hagman said the company also is working with pharmacies to ensure the drug is available.

The new guidelines, Meltzer said, emphasize three main objectives.

First, opioids should be of limited strength. Second, they should be prescribed for the shortest possible time. Third, immediate acting opioids should be preferred over timed-release versions. All three guidelines have been emphasized by the CDC in its prescribing guidelines this year.

“Give (these drugs) in a way that people are less likely to become physiologically addicted,” Meltzer said.

Meltzer said he hoped the new guidelines wouldn’t interfere with the freedom of doctors to prescribe the medications they feel will best treat their patients. If medications initially prescribed by doctors are insufficient to deal with pain, Meltzer said, patients will be able to work with their doctors to get more or different medicines. And for those with chronic, intense pain such as that experienced by some cancer patients, Meltzer said, a process has been developed to waive the guidelines.

“They’re strategic guidelines, but if they need more, their clinician or provider can work with us and we’ll make sure it’s safe and effective.”

The aim, Meltzer said, is to end the problem of over-prescribing opioids to those experiencing acute pain, pushing a wave of addiction across the nation.

Rosie Andueza, substance abuse disorder program manager for the Idaho Department of Health and Welfare, welcomed the new regulations, saying they matched emerging research showing that a major risk for addiction is being prescribed more than seven days of opioids.

“All of those changes are right in line with what we are learning to be best practices,” Andueza said. “When (newer) opioids were first released to the medical profession they were told they were a safe way to treat pain and not addictive. Now we’re clearly learning that is not the truth.”

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