Blue Cross and Blue Shield of Georgia - Pharmacy Home program
Members with increased safety risk and candidates for the program meet these criteria within a 90-day period:
• Filled five or more controlled-substance prescriptions, or filled 20 or more prescriptions, not limited to controlled substances
• Visited three or more health care providers for controlled substance prescriptions, or 10 or more providers not limited to controlled substances
• Filled controlled substances at three or more pharmacies, or filled prescriptions for 10 or more pharmacies not limited to controlled substances.
If the member does not change behavior as viewed in claim activity within 60 days of the first letter, the member will be mailed an enrollment letter requesting selection of a single pharmacy location to fill all medications, with a few exceptions, for a period of one year.
For more about the Greater Hall Chamber of Commerce’s certified Drugs Don’t Work program and the benefits of participating, visit www.ghcc.com/membership/drugs-dont-work.php.
For more information about Lanier Treatment Center, visit www.laniertreatmentcenter.com or call 770-503-7721.
Fighting prescription drug abuse, an epidemic in the United States responsible for taking half a million lives between 2010 and 2014, has become an all-hands-on-deck approach.
Now one of the largest insurers in Georgia is joining in.
“Health insurers are uniquely positioned to help improve prescription drug safety and health care quality as we have real-time access to information on medication use to determine if members are using multiple prescribers or several pharmacies to obtain their medications, which often correlates with addictive behavior,” said Mark Kishel, senior vice president and chief clinical officer for Blue Cross and Blue Shield of Georgia.
The insurer has launched the Pharmacy Home program to provide education, monitoring, proper disposal and enforcement for high-risk members in individual and employer-sponsored plans.
The goal is to reduce addiction to opioids and other prescription drugs and improve drug safety and health care quality by establishing one “home” pharmacy to fill patients’ prescriptions.
In Georgia, deaths from drug overdoses increased 10 percent between 2013 and 2014, according to the National Vital Statistics System.
More people died from drug overdoses in the United States in 2014 than during any previous year on record, according to the Centers for Disease Control, and at least half of all opioid overdose deaths involve a prescription drug.
Matthew Mote, clinic administrator at Lanier Treatment Center in Gainesville, said new programs need to focus on prevention as much as anything else.
“The options for treatment and continuum of care need to be discussed with the patients before hand and then followed up by their healthcare provider,” Mote said. “There are several factors and parties involved, and communication is vital.”
The Pharmacy Home program notifies prescribers in writing of the decision to include the insured member in the program.
The prescriber also receives a three-month member prescription history.
The need for improved communication across providers is essential, according to local health care professionals.
Even after overdosing on opioids painkillers, more than nine out of 10 people continued to receive prescriptions, according to a 2015 study published in the Annals of Internal Medicine.
“I am aware that a number of insurance companies have implemented monitoring plans and programs for their members,” Mimi Collins, CEO of The Longstreet Clinic in Gainesville, said. “It is true that today patients can be seeing multiple providers and although there is increased ‘interoperability’ and data sharing between providers – it still is not completely seamless and is sometimes contingent on a patient sharing that information.”
Bringing in other partners can also play a key role.
“There are several different modes of treatment and providers in the community that could assist the medical field in assessing and referring patients that best fits the individual and their family,” Mote said. “I think an educational program provided by the insurer could be a great prevention program for those that are being covered for prescriptions.
Prescription drug abuse was the feature of the Greater Hall Chamber of Commerce’s April newsletter.
“Prescription drug abuse can be an issue for the patient and anyone else that may have access to prescription drugs,” said Tim Evans, vice president of economic development at the Greater Hall Chamber of Commerce. “(The newsletter) was circulated among our employers participating in our certified Drugs Don’t Work program.”
The program can help businesses lower workers’ compensation premiums.
“The industry as a whole is responding through a number of efforts,” Collins said. “There is a growing number of resources and programs attempting to identify abuse and high-risk situations.”