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Addressing President’s opioid commission: limit supply and demand, promote alternative treatment

Dec 06 2017
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The opioid epidemic in the United States is a complex issue. Fixing the crisis can’t be done by just limiting the supply of drugs; it takes a multifaceted approach that includes limiting the demand, promoting evidence-based treatments for addiction and increasing law enforcement, Aetna’s Executive Vice President and Chief Medical Officer Hal Paz told the President’s Commission on Combating Drug Addiction and the Opioid Crisis.

“It’s important to recognize that as we reduce the supply of prescription opioids, we are not solving the addiction crisis,” Paz, M.D., M.S., told the commission. “Where there is demand for opioids, there will be supply in the form of illegal manufactured fentanyl or heroin.”

The Commission met for the fourth time in October in Washington, D.C., to discuss insurance issues related to the opioid epidemic. Paz spoke to the bipartisan commission about Aetna’s efforts to fight the opioid crisis.

The Commission released its full report in November 2017.

Aetna is using a three-pronged strategy focused on preventing misuse and abuse, intervening when at-risk provider and member behavior is identified and supporting members by providing access to evidence-based treatments.

Earlier this year, Aetna announced its five-year goals. By 2022, the company is committed to:

  • Increase the percent of members with chronic pain treated by an evidence-based non-opioid option by 50 percent;
  • Reduce the percent of inappropriate opioid prescribing for members by 50 percent; and
  • Increase the percent of members with opioid use disorder treated with medication-assisted therapy and other evidence-based treatments by 50 percent.

In 2016, Paz signed letters that were sent out to 1,000 opioid “super-prescribers,” or physicians in Aetna’s network identified as prescribing higher than average opioids. In 2017, Paz continued the initiative by sending letters to more than 700 dentists and oral surgeons.

“Aetna is taking a proactive approach, working with providers to reduce opioid prescribing, misuse and abuse,” Paz said. “We are using our considerable data resources to encourage prescribers to reduce misuse and prevent the diversion of unused pills.”

Paz stressed the need to promote alternative treatment. He described Aetna’s collaboration with PACIRA and the American Association of Oral and Maxillofacial Surgeons. With the collaboration, an alternative to opioids would be prescribed following a wisdom tooth extraction.

“By providing safer alternatives for pain control, fewer opioids are prescribed and we avoid the risk of misuse and diversion of unused pills,” Paz said. “We cannot simply replace generic opioids with abuse-deterrent opioids.

“We need to promote holistic treatment options that include non-opioid therapies such as nonsteroidal anti-inflammatory drugs, Tylenol, as well as non-pharmacologic modalities, such as physical therapy, acupuncture and chiropractic care, when medically appropriate.”

Paz also made suggestions to the Commission on the government’s role in fighting the opioid epidemic. Aetna believes the government should:

  • Modernize regulations that prevent health plans and providers from sharing data that could help prevent overdoses and identify individuals in need of treatment;
  • Provide greater resources to states to support neonatal abstinence syndrome programs;
  • Require electronic prescriptions for all opioids;
  • Develop a national prescription drug monitoring program; and
  • Give health plans greater flexibility to crack down on inappropriate prescribing practices in the Medicare program.