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Highmark ramps up fight against opioids

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Highmark Health will be bringing new software and new prescription limits to its fight against opioid abuse in Pennsylvania.

The Pittsburgh-based insurance carrier announced new efforts to connect doctors to data analytics software that can alert them to trends in patient use and symptoms that could increase the risk of opioid addiction.

In partnership with Nashville-based analytics firm axialHealthcare, Highmark will use claims data from its providers to identify doctors at risk of overprescribing opioid painkillers.

Axial produces a software suite for providers that tracks their prescriptions of opioids to identify potential risks and give recommendations on how to avoid overprescribing. Those recommendations can include alternative pain management techniques or a conversation with an axial pharmacist to discuss the benefits of less-addictive painkillers.

Highmark began partnering with axial in 2015 and started testing the services for providers in West Virginia in 2016. The pilot program included 250 providers in West Virginia and reduced by 25 percent the number of patients receiving opioid prescriptions from multiple providers. Known as "doctor shopping," the practice is a major risk factor for opioid addiction. 

Highmark began enrolling Pennsylvania providers at the beginning of February, and expressed optimism at the program’s efficacy.

"We expect positive results here, just as we have seen in West Virginia," said Dr. Charles DeShazer, chief medical officer for Highmark, which maintains a local office in East Pennsboro Township.

In January, Gov. Tom Wolf declared the opioid crisis a state emergency, allowing for the expansion of the state’s own prescription drug monitoring program. The program, managed through the Department of Health, integrates electronic medical records and pharmacy records to help providers and the state identify patients at risk for opioid addiction.

New prescription limits

Highmark is also imposing new limits on the length of opioid prescriptions it will allow enrollees in the company’s health plans. Highmark members who have never used opioids before will be limited to a seven-day supply of the medications starting in March.

According to a 2017 study by the Centers for Disease Control and Prevention, a patient using opioids for one day has a 6 percent chance of forming an addiction to the drug, while a patient using opioids for a week has a 13.5 percent chance of forming an addiction. At a month, the likelihood climbs to 30 percent.

According to Dr. Sarah Marche, vice president of pharmacy services for Highmark , the new policy can help fight opioid overdoses before an addiction even forms.

"The idea of this program is to stop inappropriate, long-term use at the outset," said Marche.

The new limits will impact all of Highmark’s 50 million customers nationwide. The company allows some exceptions to the rule, including for patients using opioids to treat symptoms caused by some forms of cancer.

Other companies in the pharmaceutical supply chain have taken similar steps. Last September, CVS Caremark, the prescription management end of CVS Health, implemented a seven-day limit on any prescription fulfilled for its 90 million members.

Pennsylvania ranks among the highest states in the nation for deaths caused by prescription opioid abuse. According to CDC data, overdoses are responsible for 36.5 deaths out of 100,000 in the commonwealth, more than twice the national average of 16.3 out of every 100,000.

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