Provider and Pharmacist Outreach Helps Decrease Opioid Use

San Francisco—The World Health Organization estimates that by 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide. The Office of National Drug Control Policy’s Monitoring the Future study, which is the nation’s largest survey of drug abuse among people, ranked prescription drugs as the second most abused category of drugs after marijuana.

To help reduce prescription drug misuse and abuse while helping ensure safe and appropriate Suboxone^® (buprenorphine and naloxone) use, researchers discussed the results of Aetna Pharmacy Management’s Aetna Rx Check Patient Safety program during a poster session at the AMCP meeting. The poster was titled Impact of Suboxone-Opioid Program on Opioid Utilization.

The Aetna Rx Check Patient Safety program is a retrospective drug claim review program that identifies daily overlapping Suboxone and opioid and/or tramadol pharmacy claims. Once these claims are identified, a letter including a medication profile is mailed the following day to the Suboxone prescriber. The purpose of the letter is to alert physicians of potential medication safety risks. A pharmacist follows up with the Suboxone prescriber 2 weeks after the mailing to ensure the letter was received, answer questions, and provide additional information and education as needed. Upon the prescriber’s request, the pharmacist may refer the member to Behavioral Health Case Management. On July 1, 2011, Suboxone prior authorization was implemented. Prior authorization criteria includes an opioid dependence diagnosis and enrollment in a drug addition treatment program.

Before presenting the results, the researchers reviewed the Suboxone-opioid program timeline:

• June 1, 2010: The Aetna Rx Check Patient Safety Program starts mailing letters

• January 2, 2011: Outbound calls to Suboxone/Subutex/buprenorphine prescribers begins

• July 3, 2011: Prior authorization is required for Suboxone

• January 4, 2012: Suboxone/Subutex/buprenorphine move to the medication safety list

• January 5, 2012: Prior authorization is required for Subutex/buprenorphine

The data showed that before the program was implemented, the number of opioid pharmacy claims per 1000 health maintenance organization and preferred provider organization members was increasing. When the mailing of letters to Suboxone prescribers was implemented, the number of opioid pharmacy claims had little or no change. The number of opioid pharmacy claims, however, decreased after pharmacist outreach began. A further decrease was observed when prior authorization started.

The researchers noted 1 study limitation. The addition of mailings and pharmacist outreach in 2011 for other Aetna misuse, waste, and abuse programs may also be affecting the opioid use decline.

“Informing Suboxone prescribers of Suboxone-opioid(s) overlap and pharmacist outreach to Suboxone prescribers prevented an increase in opioid use. Over time, this resulted in decreased opioid use,” concluded the researchers. “It may also be concluded that the Suboxone prior authorization process had an additional impact on decreased opioid use.”

This study was supported by Aetna Inc.