Editor’s Note: For payers and policy-makers it can be a challenge to design effective opioid epidemic measures to control the rapid increase of overdoses as program effectiveness data is being accumulated. Staying abreast as to how opioid prescription control policies are evaluated for effectiveness, payers can be more efficient in their policymaking. Click HERE and discuss how BHM helps track claims data for payers. 

opioid epidemic

BlueCross BlueShield of Tennessee will stop covering the prescription opioid OxyContin beginning January 1, 2019.

The insurance company will remove OxyContin from its list of covered drugs and replace it with less addictive pain medications. BCBS will also provide drug combination safety alerts for clinical teams and providers to highlight inappropriate or dangerous drug combinations and roll out an enhanced prior authorization requirement for extended use of short-acting opioids. The insurer will still approve prior authorization requests from members diagnosed with cancer or receiving end-of-life treatment.

BCBS leaders developed these changes with advice from a statewide panel of independent medical experts, ranging from public health officials to clinicians.

The change falls in line with a similar move from Cigna, which removed OxyContin from its covered drug list Jan. 1, 2018.

“Our clinical and social approach aims to help ensure that BlueCross members — and eventually all Tennesseans — receive the appropriate amount of opioids for their medical conditions while limiting the potential for misuse and abuse,” said Andrea Willis, MD, CMO of BCBC of Tennessee.

From 2015-18, BCBS has dispensed 19 million fewer opioid pills and reported a 26 percent decrease in opioid prescription claims.

For payers and policy-makers it can be a challenge to design effective opioid epidemic measures to control the rapid increase of overdoses as program effectiveness data is being accumulated. Staying abreast as to how opioid prescription control policies are evaluated for effectiveness, payers can be more efficient in their policymaking. Click HERE and discuss how BHM helps track claims data for payers.