narcan, opioids, opioid, narcan cpay

Aetna announces new policies to improve access to Narcan, combat overprescribing

Dec 12 2017

Aetna will be the first national payer to waive copays for Narcan for its fully-insured commercial members – a move that will increase access and remove possible financial barriers to the lifesaving drug. In addition, Aetna will limit the quantity of opioids prescribed for acute pain and post-surgery to a seven-day supply for its commercial pharmacy members. Both changes will be effective Jan. 1, 2018.

Narcan delivers one dose of the opioid overdose reversing medicine naloxone through the nose of a person overdosing on opioids. Narcan is a preferred branded medication, which may currently require a copay for members. The current copay for Aetna members ranges from $0 to $150, depending on the plan selected, but is typically in the $30 to $40 range. The copay would be waived for fully-insured commercial members once their deductibles have been met.

“Aetna is committed to addressing the opioid crisis through prevention, intervention and treatment,” said Harold L. Paz, M.D., M.S., executive vice president and chief medical officer of Aetna. “Increasing access to Narcan can save lives so that individuals with opioid abuse disorder can live long enough to get into evidence-based treatment.”

According to research from the drug manufacturer, nearly 35 percent of Aetna members prescribed Narcan between January to June 2017 did not pick up their prescription.

The data also revealed members are less likely to fill Narcan prescriptions as copays increase. The data showed a 76.7 percent prescription abandonment rate if the copay was between $100.01 and $150, compared to a 46.1 percent abandonment rate if the copay was between $40.01 and $50.

“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” Paz said. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”

Limiting acute and post-surgical opioid prescriptions to seven days for first-time prescriptions is a change designed to reduce supply, and most critically, potential for dependence. According to the Centers for Disease Control and Prevention, 6 percent of individuals who receive a one-day supply of opioids for acute pain are still taking opioids one year later. The number more than doubles to 13.5 percent for those who receive a prescription for eight days or more and jumps to 30 percent for those prescribed 30 days or more.

These initiatives are a continuation of efforts taken by Aetna to help fight the opioid epidemic and help members, who may be addicted to opioids. In March, Aetna removed barriers to treating opioid addiction by ending preauthorization requirements for commercial members on all buprenorphine products.

Aetna has also supported local community efforts in addressing opioid abuse and preventing deadly overdoses. For example, Aetna donated 720 doses of Narcan to first responders in the Northern Kentucky and Appalachia regions in August.

Aetna also announced its five-year goals to fight the opioid epidemic earlier this year. Read more about Aetna’s commitment and its strategy.