Opioid Management

States across the country are struggling to manage an alarming increase in opioid misuse and abuse amidst a national overdose epidemic. Public and private health plans are actively ensuring that members receive the most appropriate pain management and that, if needed, addiction treatment is readily accessible for their members.

We can assist health plans with opioid medication management programs, evidence-based clinical guidelines, and prescriber outreach. We have implemented a successful Medicaid opioid management program for MassHealth, which has led to a decrease in overall utilization, a reduction in the average daily dose of opioids as well as a decline in total drug costs.

Our experts keep up with, and often contribute to, the latest research and best practices in opioid management and serve on government commissions and substance abuse working groups. We have studied the effects of prior authorization on access to buprenorphine to treat opioid addiction, the impact of opioid restriction policies in a Medicaid population, helped launch new opioid recommendations, and are continually helping Massachusetts establish a safe opioid drug formulary. Our pharmacists work closely with the state's Department of Public Health Drug Formulary Commission in the development of recommendations for abuse-deterrent opioids.

Our services include:

  • Implementing opioid management programs
  • Analyzing opioid claims data
  • Developing clinical guidelines for new opioid medications
  • Managing prior authorization requests through our clinical call center
  • Evaluating opioid medication adherence
  • Training health care providers and community health workers about addiction treatment
  • Developing and facilitating a multidisciplinary workgroup of providers, behavioral health pharmacists, and front-line pharmacists who coordinate outreach to providers of high-risk members