Addressing What Matters

We're expanding our use of data and analytics to identify members who may be in the early stages of opioid addiction. The BCBSTX Controlled Substance Integration (CSI) program brings pharmacists, doctors, special investigations staff, behavioral health specialists and case managers together to identify causes that may lead to drug abuse and help improve member health and wellness.

The CSI member program builds upon BCBSTX’s Controlled Drug Substance program, in which members are identified based on factors that may affect patient safety or when they require additional intervention. Using a multidisciplinary approach, identified members undergo a comprehensive evaluation and a plan of action is executed.

The CSI provider program analyzes prescribing data and informs providers if members are using multiple prescribers and/or pharmacies for controlled substances. When we monitor providers after engaging them with this approach, we see an average 15mg reduction in morphine equivalent daily dose per patient.

The next step we’re taking in our overall opioid strategy is starting new safety checks at the point of sale to support safe and effective use of prescription opioids.

On August 1, BCBSTX launched the Appropriate Use of Opioids program, to encourage the proper use of opioids and advocate for patient safety. The program’s safety checks address the acceptable quantity and medication dose, as well as number of sources that may issue medication, as recommended by the CDC and other nationally recognized guidelines.

To avoid unnecessary disruption in current approved drug therapy, the Appropriate Use of Opioids program will use a phased approach over the next several months to implement these point-of-sale safety checks on opioid prescriptions, across our membership^*. The program’s safety checks will be in full effect by April 1, 2019.

Members who may have opioid prescriptions that are at or above the program’s established safety requirements will be identified at the point of sale, and the pharmacist will receive a notification of the steps to take before the full quantity as prescribed can be dispensed under the member’s benefits. These safety checks are in addition to current drug dispensing limits.

The safety checks in the Appropriate Use of Opioids program are put in place to lower the chance of opioid-related dangers like overdose and death.

^* The Appropriate Use of Opioids program affects employer group and individual plan business, and will not impact Medicaid or Medicare plans, at this time.

We continue to explore ways to partner with behavioral health and clinical experts to improve access to care, avoid delays in therapy and ensure members stay current with treatments. Additionally, we work closely with our pharmacy benefit manager, Prime Therapeutics, to assess our pharmacy offerings to ensure we’re keeping health care safe, cost-effective and accessible for our members.

Members suffering from opioid use disorder may benefit from Medication-Assisted Treatment. BCBSTX removed the requirement for providers to get prior authorization when prescribing medications that help relieve the withdrawal symptoms and psychological cravings for opioids.

Blue Distinction^® Centers for Substance Use Treatment and Recovery

Across the industry, there isn’t a standard way to measure addiction treatment centers. This often results in substandard, and sometimes even harmful care which slows recovery and burdens families. That’s why it’s so important to look at how we care for those struggling with opioid use disorder and make sure our members can get quality, comprehensive care.

In July 2018, BCBSTX, all 35 other Blue Cross and Blue Shield Plans and the Blue Cross and Blue Shield Association (BCBSA) committed to launch Blue Distinction Centers for Substance Use Treatment and Recovery and set up a nationwide hotline by January 2020.

Over the next few months, BCBSTX will work with BCBSA to review and find spots for Blue Distinction Centers in Texas. Once in place, these 2 assets will make sure members have access to the best clinical care and evidence-based treatment to make effective, long-term recovery a reality

BCBSTX promotes National Prescription Drug Takeback Day in our communities twice a year – part of a nationwide effort sponsored by the U.S. Drug Enforcement Administration. Safe medication disposal is one of the ways to make sure medications are not accidently used or intentionally misused by someone else.

The next National Drug Takeback day is October 26, 2019.

To make it easier and more convenient to safely dispose of unwanted medication, the Blue Cross Blue Shield Association (BCBSA) and BCBSTX are partnering with Walgreens to expand the existing Walgreens Safe Medication Disposal Program. This partnership will increase the number of drug takeback kiosks at Walgreens stores in Texas in 2018.

The Walgreens drug takeback kiosks provide a free, year-round solution to dispose of unwanted, unused or expired prescription medications, including controlled substances and over-the-counter medication.

Members can take their extra or expired medications to a Walgreens with a safe disposal kiosk and deposit them. It’s as easy as dropping a letter into a mailbox. The kiosks are available during regular pharmacy hours.

For a full list of Walgreens drug takeback kiosk locations, visit the Walgreens Store Locator .

On Oct. 24, 2018, the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (H.R. 6) was signed into law. The SUPPORT Act contains Medicare and Medicaid program enhancements and other changes, new Food and Drug Administration (FDA) requirements, and other public health efforts to help combat the opioid epidemic, such as:

• Authorizing electronic prescribing of controlled substances under Medicare,
• Expanding the ability for Medicare Advantage and Part D plans to address suspected pharmacy fraud,
• Increasing state opportunities to offer in-patient mental health coverage for adult Medicaid beneficiaries,
• Allowing for expedited FDA review of new, non-addictive drugs for pain treatment, and
• Making funding available for programs that will prevent and treat opioid addiction.

As federal agencies and states put this law into action, additional regulatory policies will be issued by agencies responsible for implementing provisions of the new law.

BCBSTX continues to work with policymakers at the state and local level to find solutions to the opioid crisis as well as advocate on behalf of our members throughout Texas suffering from opioid use disorder.

Last year, Texas was the recipient of a $27.4 million Substance Abuse and Mental Health Services Administration grant to boost efforts aimed at preventing and treating prescription and illicit opioid dependence.

During the last legislative session, a bipartisan bill was passed requiring prescribers and dispensers to check the Prescription Drug Monitoring Program database before prescribing certain controlled substances and requires dispensers to report the information after dispensing a controlled substance not later than the next business day after filling a prescription.

The Texas Legislature committees are tasked with studying and evaluating opioid abuse in Texas to determine recommendations for the 2019 legislature.

BCBSTX works closely with the BCBSA in its efforts to address the opioid crisis across the country. To know how the opioid crisis affects our members, BCBSTX worked with the BCBSA to develop The Opioid Epidemic in America: An Update which was released in July 2018. Researchers looked at a 5-year study of medical claims BCBSA and found a 29% drop in opioid prescriptions.

• BCBSA: Addressing the Opioid Crisis: Preventing Abuse and Ensuring Patients Receive the Right Care in the Right Setting
• Making the Health Care System Work: Tackling Prescribing Patterns to Combat the Opioid Crisis
• The National Institute for Health Care Management (NIHCM): Opioid Crisis at a Glance
• Prime Therapeutics: Impact of a Managed Care Pharmacist Consultation Program on controlled Substance Drug Cost, Emergency Room Visits and Hospitalizations