Hartford Business Journal

12 Hartford Business Journal • September 18, 2017 • www.HartfordBusiness.com By John Stearns jstearns@HartfordBusiness.com H ealth insurers are wielding their significant influence and claims data to address the nation's opioid crisis and are making headway in a key battlefront: encouraging doctors to prescribe fewer opioids that can turn ad- dictive and deadly. Opioid prescrip- tions rose from about 76 million in 1991 to 259 million in 2012, giving the U.S. the "dubious distinction" of being the planet's largest opioid consumer, Dr. Harold L. Paz, chief medical officer at Aetna, wrote in a report outlining the com- pany's strategy for combating the epidemic. A deluge of opioid prescriptions years in the making will take time to reverse, but insurers are urging doctors to reduce prescriptions and are seeing results. • Anthem Blue Cross and Blue Shield in August said opioid prescriptions dropped 17 percent in Connecticut in the past year and that its parent company met a national goal to reduce opioids filled at pharmacies by 30 per- cent since 2012; • Cigna in April said it reduced prescrip- tions 12 percent among its custom- ers in the prior 12 months toward a targeted 25 percent cut by 2019; • Aetna estimated prescriptions among its members could decrease 11.9 percent this year from 2016 and wants to reduce inappropriate opioid prescribing among members by 50 percent by 2022; • UnitedHealthcare said its commercial health plan members in 2015 showed a 41 percent decrease in the number of opioid prescriptions written. Steps insurers are taking to curb pre- scriptions and over- doses include alert- ing heavy prescribers and providing peer comparisons; limit- ing coverage to seven-day supplies for new prescriptions; promoting alternative pain management; supporting medication-assisted treatment for opioid addiction; and increasing access to overdose-reversing naloxone. "I do think that the medical community, particularly in Connecticut, has been galva- nized around this problem; the statistics are sobering in terms of how the usage has ac- celerated," said Dr. Richard Guerriere, chief medical officer for ProHealth Physicians, which has about 200 physicians and 150 advanced practice clinicians in the state. ProHealth is among roughly 175 U.S. phy- sician groups that signed Cigna's pledge to reduce opioid prescribing by 25 percent by 2019 and to treat opioid use disorder as a chronic condition. By April 2017, Cigna had decreased opioid prescribing across its commercial book of business by 12 percent, putting it about halfway toward its initial goal, said Dr. Doug Nemecek, a psychiatrist and Cigna's chief medical officer for behavioral health. "If we can continue this progress and get to 25 percent before 2019, we're not going to stop, we're going to keep going and go as far as we can in reducing opioids and im- pacting patients who can get care without the opioids," Nemecek said. Cigna, like other insurers, is asking physi- cians to consider alternative pain treatment. Those alternatives include chiropractic, acupuncture, cognitive behavioral therapy, physical therapy, yoga and other exercises to manage and reduce the pain, Nemecek said. "This is really about making sure that every individual is getting the best care they can, is getting healthy," he said. "We're doing what we can for patients who have pain, we're pre- venting addiction and treating people who have addiction in bet- ter ways to truly allow people to be as healthy as they can be." Doctor's perspective Cigna has collected best practices from physician groups on opioid prescribing and shares those with medical groups across its network so physi- cians can learn from each other on decreas- ing inappropriate opioid prescribing, Nemecek said. ProHealth's Guerriere said his group is combining education and clinical pro- grams to help primary care doctors with their pain-management decisions. A pain management specialist gave doctors a presentation in June on opioid prescribing, including how to properly evaluate pain and use alternative pain regiments. ProHealth also ensures its practitioners check the Connecticut Prescription Monitor- ing Program (PMP), a state database that tracks a patient's controlled substance use, including prescriptions by other providers. "If somebody is on a chronic opioid, they have to document in our electronic health record Controlling Substances Insurers, doctors work to curb opioid prescriptions "I do think that the medical community, particularly in Connecticut, has been galvanized around this problem; the statistics are sobering in terms of how the usage has accelerated." Dr. Richard Guerriere , chief medical officer for ProHealth Physicians Source: Opioid prescriptions dispensed by U.S. retail pharmacies IMS Health, Vector One: National, years 1991 — 1996, Data Extracted. IMS Health Prescription Audit, years 1997 — 2013, Data Extracted 2014. Opioid prescription trends in recent years No. of Rx (millions) Year 1991 2000 2013 250 200 150 100 50 0 Total Hydrocodone Oxycodone ProHealth Physicians Chief Medical Officer Dr. Richard Guerriere said his doctor group has taken a pledge to reduce the number of opioids it prescribes patients. HBJ PHOTO | STEVE LASCHEVER

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