Blue Cross Blue Shield of Massachusetts, one of the largest health insurers in the Commonwealth reminded its contracted providers this week that in July 2012 it implemented a prior authorization process for prescribing short acting opioids. In its September 2013 Provider Focus , a monthly publication for physicians, health care providers and their office staff, the health insurer reviewed the importance of performing a risk assessment when prescribing opioids.
Opioids are drugs such as Oxyconton, Vicodin and Percocet, usually prescribed for pain management but actively abused and sold on the street.
The good news is that Massachusetts and many other states have seen a steady decrease in the misuse of prescription medications over the past few years. However, there is still much work needed to successfully address this problem.
The newsletter lists five components of a good risk assessment for these risky drugs:
1. Family history of substance abuse
2. Personal history of substance abuse
3. Age (between 16-45)
4. History of preadolescent sexual abuse
5. Psychological disease:
a. Attention Deficit Disorder
d. Obsessive Compulsive Disorder
If any of these risk factors are present, it is recommended that the following approaches be considered:
> Provide only limited prescription amounts (e.g. 7 day supply only)
> Schedule more frequent follow up visits (e.g. weekly)
> Count number of pills at each visit
> Perform urine drug testing (to determine if other substances are being used)
> Sign responsible usage contract with patient
> Consult with other providers involved with the patient as needed.
The goal is to insure that patients with serious pain receive the medication they need to manage the pain but that people at risk for substance use or addiction, or those who are currently abusing drugs or are addicted are provided with sufficient controls so that the addiction or abuse is not easily supported.
One of the cautions noted in the newsletter was that since implementation of this risk assessment, 44% of provider prior authorization requests to the insurer indicated that a risk assessment has not been performed for the prescription of short-acting opioids.