The largest health insurer in Massachusetts is adopting a new program that could significantly limit the amount of pain medication patients receive. The policy, unveiled this week by Blue Cross Blue Shield of Massachusetts, is one of the strictest taken by a private insurer and is the latest in a series of efforts around the country to combat the prescription drug abuse epidemic by limiting access to powerful opioids.
Starting July 1, Blue Cross will allow patients to fill a 15-day prescription and one 15-day refill for short-acting painkillers, such as Percocet and Vicodin. Any further refills after 30 days will trigger a Blue Cross review, requiring physicians to certify that their patients have been counseled about the risk of addiction, as well as an agreement that all subsequent prescriptions will be written by the same doctor and filled at the same pharmacy. The latter rule is aimed at ending “doctor shopping” – in which patients go from doctor to doctor to get a prescription.
“A vast majority of our members who are prescribed pain medications use them safely and appropriately,” said Dr. John Fallon, senior vice president and chief physician executive for Blue Cross. “Still, we must also acknowledge the serious public health problem that the misuse and abuse of prescription narcotics pose to our communities, and we have a responsibility to put in place reasonable safeguards that help to prevent those problems from occurring.”
Blue Cross adopted the new policy after a review showed that 30,000 of its 2.8 million members had received prescriptions for short-acting painkillers for more than 30 days. The insurer believes that practice increases the chances of misuse, addiction and diversion – with unused pills being used by family members or being sold on the street.
The health plan will also have new guidelines for long-acting pain killers, such as fentanyl and OxyContin. Less than 3,000 of its members receive long-acting opioids. Under the new rules, those drugs could not be prescribed at all without prior authorization from Blue Cross.
Cancer patients and those with terminal illnesses will be exempt from the rules. It’s not clear how the rules will impact patients with long-term chronic pain, who do not have cancer or a terminal disease. About 100 million Americans suffer from chronic pain, according to the Institute of Medicine.
Mark Collen, an advocate for chronic pain patients, believes the Blue Cross policy will create more rules and paperwork for doctors, which could raise the cost of health care and limit access to opioids for people with chronic pain.
“This may be guesswork that may increase insurance costs when their members end up in the emergency room trying to get their pain treated,” Collen told American News Report. “It may also increase costs when their members need to see their pain doctor on a monthly basis as opposed to every two or three months. In addition, increased rules may decrease the number of doctors willing to prescribe opioids — again sending more people to the ER for pain treatment.”
Collen says there is no evidence that “pain contracts” between doctors, patients and insurers have any impact on drug abuse. He said the other rules limiting prescriptions to one pharmacy and one doctor were reasonable.
Prescription drug abuse is the fastest growing drug problem in the United States. In 2010, the Centers for Disease Control and Prevention reported that 2 million people admitted using a prescription painkiller to get high. Seventy percent of the painkillers were obtained from friends or relatives; either for free, through purchase or by theft.
According to the Massachusetts Department of Public Health, the number of prescriptions for “Schedule II” narcotic pain killers has doubled in the past decade alone, leading the agency to warn that “although it is important to properly treat pain, the availability of these prescription drugs in the community can be a risk.” Schedule II drugs include fentanyl, methadone, oxycodone, OxyContin, and Percocet.