Horizon: Opioid claims down more than 1/4 since 2013, but more work to be done

Horizon Blue Cross Blue Shield of New Jersey has seen a drop in opioid claims by about 28 percent from 2013 to 2017, the state’s largest health insurer revealed in a report Thursday.

The largest decrease in opioid prescriptions was seen in the past two years, according to Horizon’s report.

“While the results are encouraging, we are faced with daily reminders that fully understanding and combating this public health crisis requires greater collaboration and engagement at virtually every level, and Horizon is committed to that goal,” said Kevin Conlin, chairman, CEO and president of Horizon BCBSNJ. “Horizon is devoting a substantial part of the federal tax refund it is getting to increase prevention and treatment, expand community outreach and intensify our multifaceted, long-term strategy to help our members stay or become addiction-free. We are determined to continue to be a national leader when it comes to winning the fight against opioids.”

The state has taken steps to limit opioid prescriptions to five days, one of the things former Gov. Chris Christie accomplished in his final year. It was met with mixed reviews, with some medical providers saying the day limit is ambiguous.

In addition, the current administration under Gov. Phil Murphy is pushing medical marijuana as an alternative to opioids. And programs like ALTO (Alternatives to Opiates), which began at St. Joseph’s Regional Health System, are also guiding patients away from opioids.

“It takes a comprehensive, integrated strategy to tackle an epidemic as complex as opioid addiction,” said Allen Karp, executive vice president for healthcare and transformation for Horizon.

Horizon has launched several programs aimed at curbing opioid use.

“Horizon encourages nonpharmacologic and nonopioid chronic pain treatments over opioid/pharmacologic chronic pain treatment options, which is consistent with (Centers for Disease Control and Prevention) guidelines, which recommend re-evaluation of opioid therapy, and use of nonopioid alternatives to pain as initial therapy. We’re also working with some of our value-based partners to introduce alternatives in maternity episodes,” said Horizon spokesman Thomas Vincz.

The programs at Horizon include:

  • The Opioid Alert Program, in which members who meet high thresholds of morphine-equivalent doses of opioids are identified and are referred to Horizon’s Behavioral Health or case management program for intervention when appropriate.
  • Pharmacy Lock-In Program, in which members are identified as high-risk for abuse based on the number of duplicate fills for opioid prescriptions at multiple pharmacies, and limits those identified to filling their prescriptions at a single pharmacy. In 2016 alone, Horizon reached out to 12,000 Medicaid members through this program to reduce opioid use prescriptions by 37 percent.
  • Prescriber Initiatives, a program that focuses on educating prescribers on how to reduce high-risk behaviors, reduce morphine-equivalent doses, access a prescription monitoring program database and identify high-risk member behaviors.

“By leveraging best-practice education and preventive interventions that target at-risk members and prescribers, Horizon has been able to identify, intervene and prevent the abuse of opioids,” said Dr. Tom Graf, chief medical officer for Horizon. “We use advanced analytics to better understand what is happening and to stop or prevent abuse.”