Safe Opioid Use Across the Care Continuum
No recent public health issue has been more immensely discussed in the past year than how to address our country’s opioid epidemic, which claims 115 lives every day across the nation. While many debate the root causes of this issue, Express Scripts has been leading the way to minimize early opioid exposure while helping prevent progression to overuse and abuse. We’re also advocating for common sense policies to close gaps in opioid prescribing that could lead to fraud and abuse.
An effective solution for safer opioid prescribing, whether a policy change at the federal or state level, or a public-sector program, must connect each point of the care continuum -- patients, physicians and pharmacists – to be successful.
In 2017, Express Scripts was the first in the industry to create such a solution that reaches these three critical touchpoints. With our guidelines-based Advanced Opioid Management program, we are leveraging patient education, at-home safe disposal, and limits on the type and quantity of medication for first-time patients. Through this comprehensive approach, we have championed a better path toward safe opioid use, reducing the average days’ supply per claim for first-time patients by 55%, and keeping opioid prescriptions to 7 days or less for 93% of first-time patients.
We’re also re-directing 78% of new patients, who initially receive a prescription for a long-acting opioid, to short-acting opioids, which guidelines suggest are safer for patients who are new to therapy.
Public Sector Solutions
Many lawmakers at the federal and state level are making important progress to implement policies to minimize public exposure to opioid medication. We believe there are a few important policy changes, working across the care continuum, that can make a significant difference. We strongly advocate for the following:
- Required use of electronic prescribing for controlled substances. Such requirement would make opioid use safer by reducing potential medication errors, restricting pharmacy and doctor shopping, and enabling better prescription tracking, thus reducing fraud and potential misuse. We are encouraged that recent legislation approved by the U.S. House of Representatives and the Senate Finance Committee that aims to require ePrescribing of controlled substances in Medicare by 2021.
- Seven-day opioid prescription limits for acute pain. Our experience has shown limiting the amount of an opioid provided to a patient new to therapy can lead to a significant reduction in the amount of opioid medication in people’s homes, thus limiting the opportunity for misuse. We advocate for uniform limits for first-fill opioid prescriptions to seven days, with certain exceptions to ensure people in need of pain relief have access to the medication they need.
- Improve and integrate prescription drug monitoring programs (PDMPs), and require prescribers to check PDMPs. To ensure the effectiveness of a PDMP, the goal needs to be creating a PDMP that is easily accessible, easy-to-use, and integrated across the country with real-time data.The Prescription Drug Monitoring Act would compel pharmacies to submit data within 24 hours of filling a prescription. Providers would need to check the PDMP before each prescription, and PDMPs would need to notify prescribers when patients display worrisome opioid prescribing patterns.