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Addressing the Opioid Public Health Emergency in Montana

According to the Centers for Disease Control and Prevention (CDC) Learn more about third-party links, on average, 115 people in the U.S. die each day from an opioid overdose. Many of these deaths involve prescription opioids, and more than 1,000 people are treated in emergency rooms daily for misusing these drugs.

Many of our members have felt the impact of the opioid crisis in their lives and communities. Blue Cross and Blue Shield of Montana (BCBSMT) cares about the health and well-being of our more than 297,000 members, and we take this crisis and our role in addressing it seriously.

BCBSMT believes the greatest impact comes from helping members with the proper use and disposal of prescription opioid medication. We do this by building on our relationships with members, care providers and pharmacists. We’re also creating new partnerships to address the opioid crisis in the communities where our members live, work and play.

The opioid crisis is a complex issue. It will take the constant, collaborative effort of health providers, insurers, communities, members and all levels of government working together to develop solutions that can be started in towns nationwide.

Addressing the Public Health Emergency

By working with our health care partners and members in Montana, we aim to:

Identify - Use data to identify members who may be at risk of opioid addiction and abuse.
Partner to Prevent - Work with doctors, other health care professionals, and community partners (including first responders and government health agencies) to prevent or reduce the risk of addiction and abuse.
Coordinate Care - Improve the coordination of care for our members in their battle with opioid dependence.
Educate - Conduct ongoing education and outreach about the opioid crisis. This includes treatment options, local support organizations and providers that individuals can turn to for themselves, family and friends.

Leveraging Data to Address the Opioid Crisis

We’re expanding our use of data and analytics to identify members who may be in the early stages of opioid addiction. The BCBSMT Controlled Substance Integration (CSI) program brings pharmacists, doctors, special investigations staff, behavioral health specialists and case managers together to identify causes that may lead to drug abuse and help improve member health and wellness.

The CSI member program builds upon BCBSMT’s Controlled Drug Substance program, in which members are identified based on factors that may affect patient safety or when they require additional intervention. Using a multidisciplinary approach, identified members undergo a comprehensive evaluation and a plan of action is executed.

The CSI provider program analyzes prescribing data and informs providers if members are using multiple prescribers and/or pharmacies for controlled substances. When we monitor providers after engaging them with this approach, we see an average 15mg reduction in morphine equivalent daily dose per patient.

Ensuring Safe and Effective Prescription Opioid Use

The next step we’re taking in our overall opioid strategy is starting new safety checks at the point of sale to support safe and effective use of prescription opioids.

On August 1, BCBSMT launched the Appropriate Use of Opioids program, to encourage the proper use of opioids and advocate for patient safety. The program’s safety checks address the acceptable quantity and medication dose, as well as number of sources that may issue medication, as recommended by the CDC Learn more about third-party links and other nationally recognized guidelines.

To avoid unnecessary disruption in current approved drug therapy, the Appropriate Use of Opioids program will use a phased approach over the next several months to implement these point-of-sale safety checks on opioid prescriptions, across our membership*. The program’s safety checks will be in full effect by April 1, 2019.

Members who may have opioid prescriptions that are at or above the program’s established safety requirements will be identified at the point of sale, and the pharmacist will receive a notification of steps to take before the full quantity as prescribed can be dispensed under the member’s benefits. These safety checks are in addition to current drug dispensing limits.

The safety checks in the Appropriate Use of Opioids program are put in place to lower the chance of opioid-related dangers like overdose and death.

*The Appropriate Use of Opioids program affects employer group and individual plan business, and will not impact Medicaid or Medicare plans, at this time.

Caring for Our Members

We continue to explore ways to partner with behavioral health and clinical experts to improve access to care, avoid delays in therapy and ensure members stay current with treatments. Additionally, we work closely with our pharmacy benefit manager, Prime Therapeutics, to assess our pharmacy offerings to ensure we’re keeping health care safe, cost-effective and accessible for our members.

Members suffering from opioid use disorder may benefit from Medication-Assisted Treatment. BCBSMT removed the requirement for providers to get prior authorization when prescribing medications that help relieve the withdrawal symptoms and psychological cravings for opioids.

Blue Distinction® Centers for Substance Use Treatment and Recovery

Across the industry, there isn’t a standard way to measure addiction treatment centers. This often results in substandard, and sometimes even harmful care which slows recovery and burdens families. That’s why it’s so important to look at how we care for those struggling with opioid use disorder and make sure our members can get quality, comprehensive care.

In July 2018, BCBSMT, all 35 other Blue Cross and Blue Shield Plans and the Blue Cross and Blue Shield Association (BCBSA) committed to launch Blue Distinction Centers for Substance Use Treatment and Recovery Learn more about third-party links and set up a nationwide hotline by January 2020.

Over the next few months, BCBSMT will work with BCBSA to review and find spots for Blue Distinction Centers in Montana. Once in place, these 2 assets will make sure members have access to the best clinical care and evidence-based treatment to make effective, long-term recovery a reality.

Partnering to Prevent Addiction and Abuse

Safe Medication Disposal

BCBSMT promotes National Prescription Drug Takeback Day Learn more about third-party links in our communities twice a year – part of a nationwide effort sponsored by the U.S. Drug Enforcement Administration. Safe medication disposal is one of the best ways to make sure medications are not accidently used or intentionally misused by someone else.

The next National Drug Takeback day is October 27, 2018.

To make it easier and more convenient to safely dispose of unwanted medication, the Blue Cross Blue Shield Association Learn more about third-party links (BCBSA) and BCBSMT are partnering with Walgreens to expand the existing Walgreens Safe Medication Disposal Program. This partnership will increase the number of drug takeback kiosks at Walgreens stores in Montana in 2018.

The Walgreens drug takeback kiosks provide a free, year-round solution to dispose of unwanted, unused or expired prescription medications, including controlled substances and over-the-counter medication.

Members can take their extra or expired medications to a Walgreens with a safe disposal kiosk and deposit them. It’s as easy as dropping a letter into a mailbox. The kiosks are available during regular pharmacy hours.

For a full list of Walgreens drug takeback kiosk locations, visit the Walgreens Store Locator Learn more about third-party links

Opioid Policy in Montana

BCBSMT is working with key state agencies, policymakers, community leaders and partners to explore both legislative and non-legislative policy and process changes improve the way we prevent and treat substance abuse in Montana.

In 2016, the Montana Legislature established the Resolve Montana - End Prescription Drug Abuse Learn more about third-party links and Know Your Dose Learn more about third-party links programs to combat prescription drug abuse and promote responsible medication use, build awareness of the public health crisis and provide resources for health care providers, patients dealing with chronic non-cancer pain, and the general public.

Additionally, the Montana Attorney General launched Aid Montana, a campaign to address the impact of drugs and substance abuse, including opioid abuse. The initiative will serve as a starting point to map reforms to state programs and determine recommendations for the 2019 legislature.

Through the Montana Prescription Drug Registry (MPDR), prescribers, pharmacists and law enforcement can monitor controlled substances dispensed in the state or delivered to a Montana address from outside the state. Pharmacies must report all Schedule II, III, IV and V controlled substance prescriptions to the MPDR at least weekly and no later than eight days after the prescription was dispensed.

Supporting Research to Understand the Opioid Crisis

BCBSMT partners closely with the BCBSA Learn more about third-party links in its ongoing efforts to address the opioid crisis across the country.

To understand how the opioid crisis affects our members, BCBSMT worked with the BCBSA to develop The Opioid Epidemic in America: An Update Learn more about third-party links which was released in July 2018. Researchers looked at a 5-year study of medical claims BCBSA and found a 29% drop in opioid prescriptions.

Third-Party Resources