Express Scripts’ New Software Tackles Opioids as Feds Rally

Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers. 

By Diana Manos, Senior Reporter

August 11, 2017 Volume 18 Issue 15

Express Scripts Holding Co. says it’s leveraging a software application that combines utilization management, fraud prevention, care management interventions and other tools to reduce opioid misuse. The PBM’s announcement comes as a White House panel, headed by New Jersey Gov. Chris Christie (R), is calling for federal intervention on the crisis. But despite many efforts in the federal and private sector to curtail the crisis, many, including Christie, say the epidemic is a wildfire roaring dangerously out of control.

Christie’s panel — the Commission on Combating Drug Addiction and the Opioid Crisis —released a long-expected report July 27 on how to deal with the crisis. The draft report, expected to be finalized this fall, says, “Our citizens are dying. We must act boldly to stop it. The opioid epidemic we are facing is unparalleled.” The committee is calling for federal resources to help prevent and combat the disease and to “provide the easiest pathway for private providers and local and state governments to achieve success. “

“With approximately 142 Americans dying every day, America is enduring a death toll equal to September 11, every three weeks,” the White House panel says. The group is asking for states to be granted waivers from the Institutes for Mental Diseases exclusion to open up treatment options through Medicaid.

Express Scripts’ Advanced Opioid Management Solution, launched in early June, is a comprehensive program that works across the care continuum to prevent opioid use and misuse before it happens, says spokesperson Jennifer Luddy.

“As an independent pharmacy benefit manager, Express Scripts is uniquely positioned to work across the care continuum to engage prescribers, mobilize payers, and protect patients and comprehensively address the opioid issue,” she tells AIS Health. “Through our data analytics, specialized pharmacy practice, our fraud, waste and abuse management capabilities and our application of behavioral science, we have the ability to help stop abuse before it starts, from the moment a patient receives a first prescription for an opioid medication.”

According to Luddy, to develop the tool, Express Scripts analyzed opioid use among its members and asked for clients’ feedback and concerns about safe opioid use. The tool minimizes early exposure and prevents progression to overuse and abuse at three critical touchpoints: the pharmacy, with physicians and with patients, she says. Some of the methods include limiting first-time users of short-acting opioids to an initial fill of seven days. Enhanced prior authorization also is required for all long-acting opioids to block fills for new users.

“The program has a Morphine Equivalent Dose (MED) edit giving visibility to, and requiring prior authorization for, members accumulating quantities of opioid medication exceeding 200Mg morphine equivalent dose per day,” Luddy says. “Our concurrent drug utilization review (CDUR) will also ensure opioid prescriptions are appropriate, medically necessary and unlikely to result in adverse medical consequences.”

Express Scripts sends automated messages directly to all opioid-writing physicians at the point of care via their electronic medical record portal to inform them of potential duplicate therapy, misuse and abuse, drug-drug interactions, use of multiple prescribers or pharmacies — or when a patient is approaching MED thresholds, according to Luddy.

The Express Scripts tool helps patients by kicking out an educational letter after their first fill to educate them of the serious potential risks of opioid use, safe handling instructions, important restrictions and proper disposal of unused medication, she says.

In addition, Express Scripts’ opioid neuroscience specialist pharmacists conduct proactive outreach to patients triggered by one of several scenarios where the PBM’s data signals concerning patterns of use, Luddy says, such as filling two or more different short-acting opioids within the last 30 days.

Express Scripts also provides disposal bags to first-time opioid users that the system indicates are likely to have leftover medications. The bags include clear instructions for handling and disposal in a member’s home, with no driving or special disposal day required, Luddy tells AIS Health. The company also limits patients to obtaining an opioid prescription from only one doctor and to filling that prescription at only one pharmacy when the fraud, waste and abuse program detects drug-seeking behavior.

Luddy says the tool was tested through a pilot program in the Express Scripts Lab. The recent pilot study of more than 100,000 Express Scripts members, new to opioid therapy, revealed a 38% reduction in hospitalizations and a 40% drop in emergency room visits in the intervention group versus the control group during six months of follow-up, Luddy says. Half of patients received an educational letter from the Express Scripts Neuroscience Therapeutic Resource Center (TRC) and half received no intervention at all.

A subset of patients receiving the TRC educational letter who had high-risk patterns of opioid use also received a counseling call from a Neuroscience TRC specialist pharmacist, Luddy says. Among this subset, Express Scripts observed a 19% decrease in the day’s supply of opioid dispensing during six months of follow up, she says. “Patients got the medicine they need, while we helped prevent unnecessary refills that could put patients at risk of significant harm,” she adds.

In a June 21 blog, Krista Ward, senior director, Medicaid, at Express Scripts, said new solutions to fight the opioid addiction crisis “are needed now more than ever.”

According to Steve Anderson, president and CEO of the National Association of Chain Drug Stores (NACDS), a pharmacy is in a unique position to do something about the crisis. “There is often talk of the moment of truth that occurs at a pharmacy, when an individual arrives to have a prescription filled for a controlled substance,” Anderson wrote in a bylined article Aug. 4 that appeared in Drug Store News. “At that moment of truth, pharmacies and pharmacists often are caught in the middle of highly complex issues related to patient care, healthcare access, addiction, abuse, diversion.” NACDS contributed comments to the White House committee for consideration in writing their report, he said.

A white paper by Optum says there are at least two potential ways PBMs can help fight the opioid epidemic. The first is via clinical management programs, such as step therapy or prior authorization. “These are simple measures that can directly influence both physician prescribing patterns and patient use,” Optum says. “The second way PBMs can help is through a more forensic approach designed to uncover instances of fraud or abusive prescribing patterns that contribute to excessive opioid use.”

Read the White House committee’s draft report at http://bit.ly/2weCCDw, Gottlieb’s remarks at http://bit.ly/2vK7ZIW and Optum’s white paper at http://bit.ly/2fqHan4.

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