Report Recommends Insurers Get Involved in the Fight Against Opioid Abuse

Medical practice management has many challenges. Detecting a patient with a prescription drug addiction is one of the most concerning. The National Institute on Drug Abuse estimates 1.9 million Americans abuse prescription opioids. Even more alarming, overdose deaths attributed to opioids have quadrupled since 1999, outnumbering deaths from heroin and cocaine combined. As a physician, you know doubt know how difficult it can be to detect abuse. Patients often "doctor shop," seeking prescriptions from multiple physicians. Brandies University's Prescription Drug Monitoring Program Center (PDMP) recently presented a report that recommends insurers be given access to prescription history to better monitor abuse. The report, presented at the 2014 National Rx Drug Abuse Summit, has also been endorsed by the American Insurance Association (AIA).

Two Years in the Making

Analysis for the report began in 2011 when the Office of National Drug Control Policy called for a collaborative effort in its Prescription Drug Abuse Prevention Plan. Funded by a grant from the U.S. Department of Justice, in 2012 a meeting of more than 75 insurers, federal agency heads and state PDMP administrators was held to brainstorm ideas. The main consensus among the group was that insurers, including Medicare, Medicaid and workers' compensation, should have access to the prescription history of the patient. Prescription monitoring is necessary to "help provide safe and effective care and keep costs under control," according to PDMP Director John Eadie. 

How Monitoring Would Help

Insurers and other third party payers currently only have access to a patient's prescription history as it pertains to the plan for which the third party is responsible. That means a patient could access a prescription through a Medicare account by one physician, then use another insurer via another physician. Neither the physicians or the third party payers are aware of the situation, putting the patient at-risk and increasing health care costs in general. PDMP data would track each patient's prescription history for controlled substances. Access to the information would help aid in the early identification of a substance abuse problem. 

The report also includes data sharing policies and procedures, drafted by the key players during the 2012 meeting. The report and those procedures are currently being evaluated by regulatory agencies. 

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