Insurance giant Cigna recently reported that use of prescribed opioids has declined 12% among its member population in the past year, almost halfway along its previously announced goal to reduce opioid use by 25% over three years. Health plans are known to have wide swaths of data to track utilization patterns, and they can play a key role in reducing opioid use and connecting patients to treatment when necessary.
“We’ve done that through a three prong approach in addressing the epidemic by working with medical and behavioral health providers to address opioid prescriptions, chronic pain and substance use disorder,” says Doug Nemecek, MD, chief medical officer, behavioral health business at Cigna.
Prior to rolling out the plan, Cigna had seen a 14% increase in 2016 in customers seeking treatment for substance use disorders, which was on-par with national trends, he says.
Using data, Cigna has identified prescribing patterns among physicians and compared them to the Centers for Disease Control and Prevention’s voluntary guidelines. Where inconsistencies exist, prescribers are notified and reminded of the nationally accepted standards for opioid drug selection, dosage and duration of use. The goal is to help physicians implement the guidelines in everyday practice.
Starting on July 1, Cigna will begin to enforce quantity limits and prior authorization for many first-time prescriptions for long-acting opioids. Its new policy is a diametric shift from years past when Cigna—and nearly every other insurer in the United States—had no utilization management for opioids but did require prior authorization for medication assisted treatment (MAT) for addiction disorders. Cigna and a number of other managed care plans have since eliminated prior authorization for MAT.
Referral to treatment
Addiction treatment providers are also part of the insurer’s improvement plan.
“We’re actively growing our network of providers, especially those with the capacity to provide MAT for opioid use disorder,” Nemecek says. “We know that’s evidence-based and want our members to have access to that care.”
As claims data is analyzed and patients are identified for possible misuse, physicians are on task to act as the referral sources to specialized addiction treatment. Cigna has singled out certain behavioral health providers in its network that can offer comprehensive care as preferred providers.
Additionally, Cigna is in the middle of a data project with the American Society of Addiction Medicine (ASAM) to isolate best practices in addiction treatment. The insurer has provided two years worth of de-identified patient data for analysis.
“ASAM came back to us for some additional data for a deeper dive, and we’re expecting those results in the spring when we’ll be able to talk more about them,” Nemecek says.
In the meantime, he says, stakeholders are working to reduce the stigma of substance use disorders and to regard them as chronic conditions.