Many employers and plan sponsors are aware of the importance of having enhanced prevention and education options to minimize exposure to, and prevent overuse of, opioids. Here at ProAct, we are driving change across our plans to combat the progression of the opioid epidemic. ProAct’s clinical team is working both internally and with our clients to curb opioid misuse by implementing several programs.
Member Education – Opioid medications are generally safe and useful for managing acute (short-term) pain when prescribed and used appropriately. Extended or inappropriate use can lead to dependence and/or addiction. Additionally, taking these medications differently than prescribed greatly increases the chances of severe side effects, including overdose and death.
Many people are unaware of the risks associated with taking opioids. Therefore, ProAct provides resources to our clients to educate their members. These resources explain how to safely take an opioid medication, risks associated, and offer some alternative drug options.
Pharmacy Provisions – Preventative actions start at the dispensing pharmacy. In hopes of minimizing early exposure and reducing inappropriate supply, we have added a quantity limit refill provision to all short-acting opioids. These include products such as: codeine (Tylenol w/Codeine®), hydrocodone (Lortab®, Norco®, Vicodin®), hydromorphone (Dilaudid®), morphine (MSIR®) and oxycodone (Oxy IR®, Percocet®). Often times, these products are also combined with another ingredient, such as acetaminophen or ibuprofen, to provide additional analgesia.
The program is intended to work in conjunction with federal and state programs that are already in place. This program places limits on both the amount of medication and number of fills a member can have over a set time-frame for short-acting opioids. While this program is not intended to prevent members from getting medications when they are appropriate, it will help ensure that these medications are used properly, both in quantity and duration.
In addition, ProAct has added a Prior Authorization requirement on all long-acting opioids. Long-acting products are typically reserved for those in chronic pain due to illnesses, such as cancer. These include extended release versions of oxycodone (Oxycontin®), oxymorphone (Opana ER®), and morphine (Kadian®, MS Contin®) along with transdermal fentanyl (Duragesic®). This program requires that all long-acting products go through the prior authorization process to ensure the medications are being used prudently for the diagnosis.
Treatment – In addition to education for our clients, and additional provisions at the pharmacy, we have removed prior authorization requirements on products used to treat opioid dependence. Removal of prior authorization edits helps ensure access to medications, such as suboxone, used for addiction treatment. The goal is to remove barriers for those members seeking treatment for their addiction.
At ProAct, our commitment is to our clients and their members. That is why we are committed to providing resources that will contribute in keeping our partners healthy. Contact ProAct today to learn more.
-ProAct Clinical Team
