From Prescriber to Point-of-Sale:
How Employer Plan Sponsors
and PBMs Are Fighting the War
on Opioid Abuse

September 18, 2018

Nobody is immune from the effects of opioid misuse. A tragic number succumb to fatal overdoses—one every 13 minutes. Addiction also leaves its mark on both personal and professional lives. For example, those impacted by pain medication use disorder missed nearly three times the amount of work in the past year than did the general workforce. Lost productivity costs employers about $20 billion, a 2015 study found.

Safety is also an issue; employees under the influence of opioids may experience dangerous side effects—including sedation, confusion, and poor judgment— that put them, as well as others, at risk. This is especially true for employees in potentially dangerous jobs, such as big-machine operators or restaurant workers responsible for food safety. And even though opioid prescription use among people with large employer insurance coverage has declined, the cost for treatments has escalated to $2.6 billion.

Addressing the opioid problem from all angles

Only a coordinated, multifaceted approach can reverse the opioid epidemic. Plan sponsors and their PBMs need a risk management strategy that hits the problem on all fronts, such as the five-point program from OptumRx. These five areas include:

  1. Prevention and education: This includes promoting the proper use of opioid drugs by educating plan members, providers, and pharmacies about risks, dosing and duration, storage, and disposal.
  2. Minimizing early exposure by limiting opioid dose and duration of initial prescriptions as recommended by the Centers for Disease Control and Prevention (CDC). Educating members who are new to opioid therapy is also essential.
  3. Reducing inappropriate supply. This includes pharmacist safety checks at the point-of-sale to screen for dangerous opioid combinations and excess dosing, and to help avoid concurrent use of opioids and medication-assisted treatment (MAT).
  4. Treating at-risk and high-risk populations to prevent chronic use, abuse, and dependence and decrease the likelihood for fraudulent prescribing and dispensing of opioids.
  5. Supporting chronic populations and recovery using evidence-based, best practice treatment guidelines as well as advanced patient monitoring, support, and relapse prevention.

Promising results

It’s early days yet, but the signs are hopeful. PBMs that have implemented strategies and programs to manage opioid use are seeing positive outcomes:

  • By encouraging proper utilization of opioids, CVS Health has seen nearly a 72% decrease in the number of prescriptions for more than a seven-day supply. What’s more, the life-saving drug naloxone is available in 48 states to patients at CVS Pharmacy locations, without an individual prescription.
  • In less than two months, OptumRx saw a 65% decrease in prescriptions for first-fill acute opioid treatment written above the maximum 7-day supply and a 14% reduction in average dose across all opioid prescriptions.
  • During the first 90 days of its program, Express Scripts delivered nearly a 60% reduction in average days’ supply for new opioid-prescribed patients.
  • EnvisionRx also reported impressive results, such as an annual 42% reduction in the number of opioids filled. In addition, the company notes that these programs help control indirect costs such as absenteeism, presenteeism, and added medical expenses due to opioid abuse.

A safe place to work—and recover

PBMs play a critical role in successfully reversing the effects of the opioid crisis. Most of them demonstrate an unwavering commitment by offering opioid management as part of their core services to plan sponsors. One area where they can make a significant difference is assisting employees or members who struggle with opioid misuse. Too often, these individuals fear they will lose their job if they seek help. PBMs can encourage the adoption of return-to-work policies that offer a safe haven. And by supporting local recovery programs, PBMs can improve access to recovery and treatment options in local communities. If you’re a plan sponsor, check with your PBM or pharmacy benefit consultant to see how you can help win the war on opioid misuse.

Learn more about the causes of the opioid crisis in our first blog post in this series. Next time, I’ll discuss additional strategies that employers and other plan sponsors can consider.