Measuring the Impact of Opioid Crisis Management

America’s opioid epidemic is not over. On average, 130 Americans die every day from an opioid overdose, according to the Centers for Disease Control and Prevention (CDC).

That is why Express Scripts remains focused on our solution to help sponsors protect themselves and their members from the physical, emotional and financial effects of this epidemic with a program that is proving to minimize exposure to opioids and help prevent progression to overuse and abuse.

Our Advanced Opioid Management^® solution went into effect Sept. 1, 2017, and was the first comprehensive solution on the market to seek to influence behavior at every touchpoint. Through rigorous review, we have continued to build upon the initial components and expand our solution based on internal analysis, regulatory guidance, CDC data, and industry need. 

Two years later: Still leading the industry in protecting patients

On September 1, 2019, we enhanced our Advanced Opioid Management program with added utilization management edits and functionality to this already robust program, staying current with evolving market needs. 

With more than 17.4 million members enrolled, clients that have elected to use our program have seen significant outcomes. 

Opioid abuse can start when over-prescription occurs, so we’ve taken a proactive approach to seek to influence behavior, starting with the first fill. Results since implementing enhancements to our program include:

• A 57% reduction in average day supply per claim for first time opioid users (A 2.1% increase from our program results prior to enhancements, 55.3% to 57.4%)
• 96.5% success rate of patients were dispensed a 7-day supply or less of medications (Nearly a 4% increase from our program prior to enhancements, 92.8% to 96.5%)
• An additional full day reduction on the average day supply of the second claim (8.2 days to 7.1 days)

Special measures for the pediatric population

Working to prevent opioid abuse affecting the pediatric patient population also is key to our program, and with our enhancements we’ve achieved this result:

• 99.2% success rate of pediatric patients dispensed a 3-day or less of medications.

This impact is significant since a recent study found that between 1999 and 2016, the misuse of prescription and illicit opioids caused the deaths of approximately 9,000 American children. Concurrently, the pediatric mortality rate from opioid poisoning increased more than twofold. In addition to this, the 2017 National Survey on Drug Use and Health estimated that about 769,000 children aged 12 to 17 misused opioids. Our work to protect this population remains critical.

Ensuring the lowest effective dosage 

According to the CDC, when opioids are started, clinicians should use caution when prescribing opioids at any dosage and should prescribe the lowest effective dosage. In addition, the CDC guidance says they should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day.

Every day, we work to support prescribers by helping to identify safety risks and flagging them for thousands of physicians across the country. We enable prescribers with integrated patient data and safety alerts delivered right through their electronic health record. 

Using more than 4,000 evidence-based clinical rules, Express Scripts’ real-time alerts help avoid hospitalizations and promote safer use of medication by ensuring prescribers have a more complete picture of their patient’s history. 

Through our enhanced program, we’ve made these impacts:

• 77% of patients prescribed a long-acting opioid as initial therapy were redirected to a safer, short-acting prescription
• 40.6% reduction in the average morphine milligram equivalent (MME) for first time opioids users
• 95.8% success rate of members were dispensed an opioid claim at or below 90 mg MME

Education, proactive care and safe disposal 

In addition to enhancements at the point of care and point of sale, we’re providing patients with additional education and support, including:

• Outbound phone calls from our pharmacists to support members prescribed medication assisted treatment (anti-craving medicine)
• Suicide, mental health and addiction hotline resources on member-facing materials
• Educational letters with advanced member care and private, customized consultations if members meet 1 of 5 proven trigger warnings
• Deactivation device kits to help members safely dispose of excess opioid

We continue to drive powerful impact, and launching our solution has resulted in increased support for 17.4 million members, 17.8 million pills able to be disposed, via the safe disposal bags we’ve provided, and 1.8 million member education letters mailed.

As evidenced by early results, our enhanced program offers resources to our clients that can minimize early opioid exposure and help prevent overuse and abuse.