Pharmacy Programs That Tackle Inappropriate Opioid and Rx Drug Use Can Improve Drug Safety and Health Care Quality

INDIANAPOLIS–(BUSINESS WIRE)–Insurers can and should play a role in helping to reduce the rate of
drug overdose and improving quality of care. That’s why Anthem, Inc.’s
affiliated health plans have launched a program to help reduce addiction
to opioids and other prescription drugs and improve drug safety by
enrolling high-risk members in individual and employer-sponsored plans
in the Pharmacy Home Program, which limits drug coverage to one
member-chosen home pharmacy.

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, with nearly half a million people in the United States dying
from drug overdoses between 2010-2014. Sixty percent of drug overdoses
resulting in death involved narcotics. At least half of all opioid
overdose deaths involve a prescription opioid.

“Clearly, the overuse and abuse of prescription drugs has evolved into a
national epidemic and a public health emergency,” said Colleen Haines,
Anthem vice president of clinical and specialty pharmacy. “Health
insurers, such as Anthem, are uniquely positioned to help improve
prescription drug safety, health care quality and outcomes as they 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.”

The Pharmacy Home Program, which began on April 1 with distribution of
letters to eligible members, focuses on a small but extremely high-risk
segment of members in Anthem health plans in 14 states. Those who a have
diagnosis or prescription history for HIV, sickle cell anemia, multiple
sclerosis, cancer and hospice and palliative care are exempted from the

Even after overdosing on opioids – a class of painkillers — more than
nine out of 10 people continued to get prescriptions for them, according
to a 2015 study published in the Annals of Internal Medicine. And, some
patients went on to suffer another overdose. Seventy percent of patients
who overdosed later received prescriptions from the same health care
professional who prescribed opioids before their first overdose.

“Collaborating with prescribers is key,” Haines said. “Because many
medical information systems are not integrated, prescribers may not be
aware that their patient has overdosed or that a patient is getting
several prescriptions for the same drug or many, many other drugs from
multiple doctors.”

The Pharmacy Home Program notifies prescribers in writing of the
decision to include the member in the program. The prescriber will also
receive a three-month member prescription history and an education piece
on the advantages of one pharmacy to review with the member.

Members with increased safety risk and candidates for the Pharmacy Home
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
  • Filled controlled substances prescriptions 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.

“We know from Medicaid programs that efforts like this can result in
large drops in opioid prescriptions and lead to more appropriate
treatment for substance abuse and pain management,” said Dr. Sherry
Dubester, Anthem vice president of behavioral health and clinical
programs. “Programs like these are just one part of an overall strategy
to help prevent addiction, re-direct consumers to appropriate care, and
hopefully, prevent deaths and major medical problems from overdose and
drug interactions.”

About Anthem, Inc.

Anthem is working to transform health care with trusted and caring
solutions. Our health plan companies deliver quality products and
services that give their members access to the care they need. With over
72 million people served by its affiliated companies, including more
than 39 million enrolled in its family of health plans, Anthem is one of
the nation’s leading health benefits companies. For more information
about Anthem’s family of companies, please visit


Anthem, Inc.
Lori Mclaughlin, 317.488.6898 or 317.407.7403 (cell)