Health Insider Update

The addiction to and abuse of opioids such as morphine, heroin, and prescription painkillers is a serious problem that affects the economic, health, and social welfare of all societies.

In 2012, an estimated 2.1 million people in the US suffered from substance abuse disorders related to prescription opioid painkillers. That number has only increased since. These people are now finding help from an unexpected source: insurance agencies.

In an effort to reduce the abuse of Vicodin, Oxycontin, and other painkillers, some health insurers in Massachusetts are limiting a patient’s initial painkiller prescription from a 15-day supply to a 7-day supply. The change will go into effect next month.

For many victims, the key to recovering from addition is support. Amanda Jean Andrade lives in a halfway house in Boston and has been completely sober since October. Amanda credits her success to her case manager, Will.

“Having Will is the best thing in the world for me,” says Amanda. “Because if I have the slightest issue with anything to do with my insurance that includes, like, prescriptions, – even when I had a court issue – I know that I can call him.”

Will works for CeltiCare Health Plan, Amanda’s insurance company. CeltiCare and several other Massachusetts insurance companies are taking aggressive steps to combat the growing painkiller epidemic.

Most insurers cover some inpatient substance abuse treatment, but these are only short-term solutions that lead to relapse and readmission, explains CeltiCare CEO Jay Gonzalez.

This is why CeltiCare decided to start assigning social workers to some of its members. “This is the biggest potential solution to this problem, I think, because at the end of the day we have to find the members who are or could be in trouble, and we need them to be invested in addressing their issues,” says Gonzalez.

For insurance companies like CeltiCare, the costs associated with the opioid epidemic are vast: nearly one fourth of its hospital admissions are connected to substance abuse. CeltiCare spent over 10% of its annual budget last year on Suboxone, a medication prescribed to treat narcotics addictions.

Gonzalez hopes that spending extra time and effort to help patients like Amanda will pay off in the long run by helping them attain sobriety without relapse. “At the end of the day, I think it’s going to cost a lost less,” says Gonzalez. “They’re going to be healthier; they’re not going to be showing up in the emergency room. We have people who show up in the emergency room 50 to 100 times a year. That’s very expensive, and it’s not goo for the member.”

CeltiCare is also training addicts and their families to use Narcan, a drug developed to reverse an opioid overdose. I mentioned above that the agency plans to cut the initial prescription of painkillers down to 7-days by February.

Massachusetts’ biggest insurance company, Blue Cross Blue Shield, is also limiting the supply of painkillers it allows patients for their initial prescription.

Since most substance abuse problems originate as legitimate prescriptions, limiting prescriptions is a straightforward way to stop the problem at the source, explains Blue Cross Blue Shield associate chief medical officer Dr. Tony Dodek. “We decreased the number of doses in circulation – when you compare the 3-year period after implementation to the prior period – by over 21 million doses.”

A harder task is finding ways to keep people out of the hospital. Between 1993 and 2012, the percentage of inpatient hospital stays due to opioid use increased by 150%. Health insurance agencies are trying to lower this number by screening members, hiring social workers to improve chances of recovery, and teaching the use of medicines like Suboxone.