Amid a nationwide opioid addiction crisis, payers must look well beyond simply containing costs and work closely with doctors who are prescribing these powerful pain medications, says Tyson Thompson, PharmD, a clinical consultant pharmacist at UMass Medical School.
Thompson points to two opioid management strategies being utilized by clients of UMass Medical School’s Clinical Pharmacy Services.
Under a program developed for one client, patients prescribed high doses of opioid-based pain medication are first required to consult with a pain management specialist and have a patient prescriber agreement in place with their physician.
The aim is to see if there are alternatives that might be explored, Thompson notes. “That is to try and essentially get everything in line and make sure they have exhausted non-opioid treatments first,” he said.
This emphasis on seeking non-drug pain relief comes as drug overdose deaths across the country “likely exceeded” 59,000 in 2016, a 19 percent increase over the year before, according to The New York Times.
Working with prescribers is another strategy employed by the Opioid Therapeutic Class Management Workgroup, a program for the Massachusetts Medicaid program, MassHealth, in which Thompson is involved.
The multidisciplinary workgroup includes a practicing internist and several pharmacists, including those who specialize in psychopharmacology.
The group discuses Medicaid members who may be high-risk because of they are taking doses of opioids or have complex prescription regimens. In some cases, the team creates individualized plans to address specific issues.
“We collaborate with the prescriber to drive safe and judicious opioid use. And we can establish a collaborative relationship with that prescriber,” Thompson explained.
The initiative has led to a drop in overall use of opioid-based medications, including a reduction in average daily doses and a decline in total drug costs.
Nearly 25 percent of individuals who are enrolled in Medicaid across the U.S. were prescribed an opioid pain medication in 2015, Bloomberg News reports, citing a survey by Express Scripts Holding Co.
“We focus not only on trying to contain costs, which is very common, but also trying to focus on safe and judicious opioid use,” Thompson said.