New recommendations on how pharmacists should manage opioid prescriptions are expected to be released by Gov. Deval Patrick’s Opiate Emergency Task Force this month and Paul L. Jeffrey, PharmD, pharmacy director at Commonwealth Medicine and an active participant on the task force, said pharmacists will embrace the suggestions.
“The pharmacy-provider community—not just now, but for some years—has been clamoring for better practice guidelines, best practices on how to handle these uncomfortable situations where they recognize a pattern of misuse or abuse, but feel somewhat powerless to do something about it, and that’s something that is likely to change as a result of the opiate task force,” Jeffrey said.
Chaired by Massachusetts Department of Public Health (DPH) Commissioner Cheryl Bartlett, the task force was charged with investigating the state’s opioid crisis and issuing recommendations that include new laws and policies. Draft recommendations have been released, with a full report anticipated soon.
Final recommendations are expected to include the creation of new regulations for pharmacists and insurers that outline safe ways to dispense opioid prescriptions. Those guidelines would help both groups understand and address suspicious activities and trends. Jeffery said suspect opioid prescription practices seen by pharmacists include physicians who prescribe only opioids, patients who repeatedly fill prescriptions with high quantities and patients traveling great distances from their homes to fill prescriptions.
“Pharmacists get frustrated by this of course,” said Jeffrey, who explained that there is no formal mechanism for cataloguing these suspect practices. Pharmacists are independently using their professional judgment, which means a pharmacist in one community may deny a prescription only to have it filled by a pharmacist in another community.
The task force may also recommend requiring pharmacists and prescribers to check utilization patterns for misuse and abuse in the Massachusetts Prescription Monitoring Program. Jeffrey said the task force also focused on education programs for pharmacists and patients. Pharmacists may be asked to educate patients when filling opioid prescriptions. Pharmacists may also be required to distribute naloxone, a drug that reverses the effects of an opioid overdose.
“It’s likely that there will be an increased emphasis on pharmacies dispensing these naloxone kits for at-risk individuals and their families,” Jeffrey said.
Jeffrey is a pharmacy director in the Office of Clinical Affairs within the Center for Health Policy and Research at UMass Medical School's Commonwealth Medicine division. In this position, he serves as director of pharmacy for the Massachusetts Medicaid program, MassHealth. Jeffrey provides broad clinical support to MassHealth, and has introduced innovative programs in the areas of opioids and pain management, as well as behavioral and mental health.
One successful opioid management program implemented by the Office of Clinical Affairs is detailed in a paper co-authored by Jeffrey, Implementation of an Opioid Management Initiative in a State Medicaid Program, which was published in the May edition of the Journal of Managed Care Pharmacy.
That opioid management program resulted in decreased overall utilization, lower dosage amounts used per member and, lastly, a reduction in drug costs. The initiative’s management strategies included determining medical necessity, requiring step therapy and implementing high-dose limits. The program aimed to establish best practice guidelines with a focus on improving quality of care while also reducing fraud, waste and abuse.
The Office of Clinical Affairs supports a full range of medical management functions, including clinical policy, utilization management, pharmacy, quality, clinical informatics, and oral health on behalf of MassHealth. The office ensures that patients receive medically necessary, appropriate, cost-effective, quality care — in compliance with state and federal regulations.