As the opioid crisis continues to claim lives and harm families and communities across the country, Aetna is seeing progress on stemming the tide of heroin and prescription painkiller misuse and abuse.
“It’s clear that Aetna is on the right path in working to help our members fight opioid misuse and abuse,” said Daniel Knecht, M.D., vice president of clinical strategy and policy. “We are constantly looking for additional ways in which we can positively impact this terrible epidemic and improve the health and lives of our members and, subsequently, their families and communities.”
Aetna is aiming to reduce inappropriate opioid prescribing to members by 50 percent by 2022. The company is also aiming to increase the percentage of members with chronic pain treated by non-opioid treatment alternatives and those using medication-assisted treatment (MAT) for opioid use disorder both by 50 percent by 2022.
“These goals are Aetna’s North Star – they are benchmarks against which all of our opioid efforts will be measured and the standard to which we hold ourselves accountable,” said Harold L. Paz, M.D., M.S., executive vice president and chief medical officer for Aetna.
A Tale of Two Years
Aetna’s goals align with the company’s larger, comprehensive strategy to help combat the opioid epidemic. In Aetna’s opioid strategy paper published in June 2017, Paz noted how the company is using data analytics, clinical insights and collaborations to drive improved outcomes.
Aetna created an enterprise-wide opioid task force in 2016, which is chaired by Paz. The task force is made up of representatives from various business areas, including Health & Clinical Services, Medicare, Medicaid, Pharmacy, Dental and Behavioral Health.
In 2016, Aetna analyzed its claims data to identify over 1,000 physicians, called super-prescribers, who were substantially over-prescribing opioids. Those physicians were sent letters alerting them to their outlying prescribing patterns and providing CDC guidelines for appropriate opioid use in chronic pain management.
That same year, the company removed pre-certification requirements on buprenorphine products to promote the use of MAT for opioid use disorder. In addition, Aetna placed this class of medications on the preventive medicine list to reduce members’ copays whenever possible.
In 2017, Aetna continued the initiative and identified and sent letters to over 1,000 dentists and oral surgeons who were over-prescribing opioids to patients. In the letters, Paz provided prescribing guidelines that are targeted to these groups of health care providers.
In 2018, Aetna began limiting opioid prescriptions for acute pain to a seven-day supply and 90 MME/day limits for commercial members. These limits reflect CDC guidelines to reduce the potential for opioid abuse and dependence.
This year has seen additional initiatives, including empowering members to make informed decisions about opioid alternatives.
By providing coverage for EXPAREL for wisdom tooth extractions, members have access to a safe and effective pain treatment option that can provide relief for the first few days following a procedure. As part of this strategy, Aetna has enhanced its online provider search tool, DocFind, to help members search for providers who offer opioid alternatives like EXPAREL.
An innovative pilot program for members who have experienced an opioid overdose launched in May. The “Guardian Angel” pilot program reaches out to members during one of the most critical moments for potential recovery: a nonfatal opioid-related overdose.
Through Guardian Angel, Aetna’s specially trained clinical staff educates victims on treatment options in their communities and connects them with local health care providers and social support services. With the member’s permission, these clinicians also reach out to family members and care givers to arm them with key resources and offer additional support.
Click here to read more about how Aetna is fighting the opioid epidemic.