Health Insurers in Massachusetts Use New Measures to Address Opioid Crisis

Health insurance companies in Massachusetts are trying new ways to address the opioid crisis. Some are imposing restrictions on prescriptions for OxyContin, Vicodin and other painkillers, while others are calling and visiting members being treated for addiction.

Blue Cross Blue Shield of Massachusetts put limits on opioid prescriptions three years ago. It is now contacting members who are in detox programs to help coordinate their care and prevent relapses, The Boston Globe reports. Staff members at Boston Medical Center HealthNet Plan call and visit members being treated for addiction to help them locate and stick with treatments.

Neighborhood Health Plan has partnered with Massachusetts General Hospital to hire a recovery coach to help members diagnosed with a substance use disorder. “If we’re able to learn that attaching someone to a recovery coach early reduces recidivism, it would easily be worth the investment,” said Neighborhood’s Chief Medical Officer, Dr. Paul Mendis.

A small health insurance company called CeltiCare is spending more than 10 percent of its $24 million prescription drug budget on the addiction treatment Suboxone—more than it will spend on any other drug. Many of the company’s 50,000 members are low-income people on Medicaid. Some are homeless and many have chronic diseases. Almost one-quarter of all hospital admissions CeltiCare covers are related to substance use disorders.

The insurer has begun limiting prescriptions of opioid painkillers to 15 days at a time. Doctors who want to prescribe more than that must fill out additional paperwork. Patients being treated for addiction do not need prior-authorization requirements for all treatments, including detox programs, outpatient care and medication.

CeltiCare this fall began offering training to its members who take opioids, both legally and illegally, and their families, in how to use the opioid overdose antidote naloxone.