One of America’s largest health insurance companies recently took major to combat the opioid epidemic by waiving copays for the overdose-reversing nasal spray Narcan. Effective New Year’s Day, Aetna removed the financial hurdles that kept some from accessing and using this potentially life-saving medication. In addition to waiving co-pays for Narcan, Aetna also limited the quantity of prescription painkillers for acute pain and post-surgery to a seven-day supply.
Harold L. Paz, MD, MS, executive vice president and CMO for Aetna stated the following:
“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose…By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”
The co-pay waiver for Narcan is in response to the high percentage of members who didn’t pick up prescriptions for the medication due to cost. Members who are currently making copayments for Narcan range from no cost to $150. On average, Aetna members pay between $30 and $40 for the opioid reversal drug.
Data shared by Aetna management shows that as copays increase, the less likely members filled their prescriptions. There was 76.7 percent prescription abandonment rate if the copay was between $100.01 and $150, compared to a 46.1 percent abandonment rate if the copay was between $40.01 and $50. Aetna’s copay waiver will apply to nearly 5 million of its fully-insured commercial members. This will exclude 13.5 self-insured medical members whose co-pay structure will remain unchanged until their self-insured employers decide the waiver into their plans.
A Bold Step Forward
Aetna’s decision to waive Narcan co-pays is a bold step that has met with both praise and criticism. For those in support of the waiver, having wider access to Narcan and other life-saving medications is needed during the current drug crisis. By making it more affordable, more people can obtain Narcan and can use the drug in case of an accidental overdose.
However, this move by the insurance giant has been with criticism regarding the limiting of opioid medications to a seven-day supply. Leo Beletsky, JD, MPH, an associate professor of law and health sciences at Northeastern University in Boston, said the following:
“Research suggests that needs for postoperative opioid use are highly varied, depending on the procedure and the patient. Those modal needs vary from 3 to 14 days… I agree that we need to moderate opioid prescribing to align it more closely with what is necessary and appropriate, but across-the-board mandates and limitations of this sort are not driven by evidence and can be counterproductive.”
Aetna implemented this measure in hopes of decreasing the chance for opioid dependence. According to statistics from the CDC, only 6 percent of individuals who receive a one-day supply of opioids for acute pain are still taking these medications one year later. For those who receive prescription painkillers for eight days or more, 13.5 percent are still using those medications one year later. Additionally, 30 percent of patients who have painkiller prescriptions for more than 30 days continue to use medications a year later.
Aetna’s Five-Year Plan to Stop the Opioid Epidemic
Aetna’s co-pay waiver is part of their five-year plan to curb the nation’s ongoing opioid crisis. The company looks to reduce inappropriate prescribing of painkiller medications to members by 50 percent by 2022. Also, the company is looking to adopt a multi-faceted approach in treating opioid and other drug addiction by using medication-assisted treatment.
Aetna’s comprehensive strategy looks to prevent misuse and abuse. In achieving this goal, they identify at-risk behavior and support those patients who seek evidence-based treatments. The following press release outlined four major areas of focus:
Aetna has long sponsored programs to educate dentists (who write 1 in 8 opioid prescriptions) about the dangers of opioids. Aetna also works with dentists to manage and end opioid use by encouraging them to take the least amount possible for the shortest period necessary to treat acute pain.
Aetna promotes the appropriate use of opioids by analyzing their claims database. If patterns of suspected misuse or abuse is observed, the company will intervene if there is evidence of abuse. For example, Aetna notifies physicians if patients are taking more than three opioids, or if they have multiple prescriptions.
As opioid-related overdoses and deaths continue to increase, Aetna has ended the preauthorization requirements on all medication-assisted therapy medications such as buprenorphine. Ending the requirement for buprenorphine will increase access to treatment and increase the chance of recovery for those addicted to opioids and other drugs.
Aetna continues to help find the most effective ways to help people recover. We are beginning to develop value-based contracts with drug and alcohol rehabilitation centers to promote evidence-based approaches to substance use disorders.
The company has also taken a proactive stance against doctors and other medical professionals who overprescribe medications. For example, Aetna’s Chief Medical Officer sends letters to the top 1 percent of opioid prescribers to alert them of their prescribing pattern. Additionally, these providers are provided educational materials about the CDC’s checklist for prescribing pain medications for chronic pain.
Aetna also had pushed for electronic prescriptions for controlled substances to reduce the risk of errors, overprescribing and fraud. Additionally, they have increased the focus on Prescription Drug Monitoring Programs (PDMP’s) allowing for cross-state sharing of information to reduce instances of abuse.
The Struggle is Real…and Deadly
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