BCBS requires pre-approval to curb painkiller abuse

May 10, 2012 | By Dina Overland

In an effort to curb drug abuse, Blue Cross Blue Shield of Massachusetts has implemented a strict, new policy requiring its members to receive pre-approval to take certain pain medications.

Under the program, Blue Cross members can fill two 15-day prescriptions for common short-acting painkillers, including Percocet and Vicodin, but any additional refills will require members to obtain approval from the insurer. The additional refills also will require the member's doctor confirm that certain conditions have been met, such as counseling the member about the risk for addiction, and agreeing that only he or she will write all subsequent prescriptions to be filled at the same pharmacy or chain, reported The Boston Globe.

The new Blue Cross program also states that long-acting painkillers, such as fentanyl and OxyContin, can't be prescribed at all without members first obtaining authorization, according to American News Report.

Such a program is necessary, Blue Cross said, because an internal review revealed that more than 30,000 of the insurer's 2.8 million members received prescriptions in 2010 for opioid painkillers lasting longer than 30 days--a practice believed to lead to drug misuse and dependency.

Indeed, a national study of almost 76,000 urine screens conducted by Quest Diagnostics showed high rates of prescription misuse among people across all ages, income levels and government and commercial health plan coverage. In the survey, 44 percent were using pain medications, reported FiercePracticeManagement.

Blue Cross Chief Physician Executive John Fallon said the insurer worked with pain care and addiction specialists for 18 months to ensure their plan balances patients' needs with the goal of limiting drug abuse. "The alternative is to just continue the way we have been doing this, and we will have more people addicted,'' Fallon told the Globe.

Reducing prescription abuse also could lead to future savings for Blue Cross. Blue Cross Medical Director Jan Cook said the insurer probably only would save a modest $200,000 a year with members filling fewer prescriptions; however, successfully curbing addictions could mean avoiding expensive substance abuse treatments down the road.

To learn more:
- read the Boston Globe article
- see the American News Report article