Insurers Share Innovative Strategies to Tackle Opioid Abuse

by Lauren Kelly

Though Part D sponsors have for years been targeting beneficiaries at risk for opioid abuse through CMS’s overutilization monitoring system and will soon implement drug management programs as required by the Comprehensive Addiction and Recovery Act of 2016, many are seeking to go beyond program requirements to address and prevent opioid overuse. Several organizations shared details of their comprehensive opioid strategies during a session of CMS’s Fall Conference and Webcast, held Sept. 6 in Baltimore.

Jaclyn Jacobson, manager of Medicare programs with Martin’s Point Health Care, said “benefit agility” is a critical component of the not-for-profit insurer’s opioid strategy. That means working with members, providers and the community to not only prevent opioid overuse but also to alleviate existing opioid overuse, remove barriers to appropriate care and provide needed supports, she explained.

Also taking a multidisciplinary approach is Aetna Inc., which has built its comprehensive opioid strategy around three pillars: prevention, intervention and support, said the insurer’s Medicare chief pharmacy officer, Erin McKenna, who spoke on the panel.

One recent effort that pulled all three of these components together is Aetna’s Guardian Angel Program, which piloted this year. Using data analytics to identify members who recently had an overdose event or show some other at-risk red flag, the program deploys a specially trained nurse to “very quickly” reach out to members telephonically and offer them services and supports, such as performing medication reconciliation or guiding them to addiction service providers.

“They may or may not be ready to discuss therapy. They may need more social support; they may need help in finding a provider that can get them on the road to treatment” or in connecting with programs in their communities, all while using Aetna as a “touch base,” explained McKenna. And even though the program is still in its early stages, she said members are “likening it to a lifeline.” Aetna is continuing to refine the model in the hopes of expanding it.