Press Release: Thursday, July 12, 2018

Massachusetts leads nation in reducing opioid prescriptions

Massachusetts leads nation in reducing opioid prescriptions

Improvement follows launch of Blue Cross Blue Shield of Massachusetts' Prescription Pain Medication Safety Program

Blue Cross Blue Shield of Massachusetts

July 12, 2018 

A new study from the Blue Cross Blue Shield Association found that the number of prescriptions for opioid-based medications among its commercially insured members in Massachusetts plummeted 51 percent between 2013 and 2017 -- the biggest drop in the nation. The results come in the wake of a groundbreaking prescription safety program launched by Blue Cross Blue Shield of Massachusetts in 2012, before the opioid epidemic was widely recognized as a crisis.


Massachusetts leads nation in reducing opioid prescriptions

"Our Prescription Pain Medication Safety Program has had a substantial impact on opioid prescribing habits in the Commonwealth, helping to reduce the risk of misuse of these powerful narcotics," said Bruce Nash, MD, chief physician executive at Blue Cross Blue Shield of Massachusetts.

Nationally, there was a 29 percent decline in opioid-based medication prescriptions among Blue Cross Blue Shield commercially insured members. Massachusetts was the state with the fewest prescriptions for these pain medications. There were 193 opioid-based prescriptions written for every 1,000 Blue Cross Blue Shield members in Massachusetts in 2017. The national average was more than double that, at 394. The data was released today by the Blue Cross Blue Shield Association in its latest Health of America Report and may be an indication that actions on the local, state and national level are having an impact on the misuse of opioid-based drugs.

The significant drop in opioid-based prescriptions comes amid the state's efforts to address the opioid crisis, including landmark legislation signed by Governor Charlie Baker in 2016 that instituted the nation's first seven-day limit on first-time opioid prescriptions. The law also requires prescribers to check the Massachusetts Prescription Awareness Tool (MassPAT) before writing any new opioid prescriptions. The online tool links the Commonwealth's patient prescription data-sharing capability with 32 states, in order to track prescriptions and reduce the risk for opioid prescription misuse and diversion.

"Solving the nation's opioid epidemic takes strong partnerships among the medical community, health insurers and government. Programs such as Blue Cross' Prescription Pain Medication Safety Program are leading the way in addressing this health crisis," said Massachusetts Secretary of Health and Human Services Marylou Sudders. "We are encouraged to see opioid-related deaths declining and prescriptions for Schedule II drugs significantly decreasing in Massachusetts, but we know that there is significant work ahead to increase access to treatment and to help individuals find the path to recovery across the state."

Catalyst for change

In July 2012, Blue Cross Blue Shield of Massachusetts launched its Prescription Pain Medication Safety Program, a first-of-its-kind effort that implemented expert-defined best practices for the appropriate prescribing of opioid-based medications. In its first five years, the program reduced the number of prescriptions for these painkillers by an estimated 60 million doses, reduced claims for short-acting opioid medications including Vicodin® and Percocet® by 28 percent, and reduced claims for long-acting opioids like OxyContin® by 45 percent.

The program includes the development of a treatment plan between patient and physician that considers non-narcotic options, requires prior authorization for short-acting opioids prescribed for more than 21 days and for all long-acting opioids, requires the use of a single pharmacy for each patient's opioid prescription and a risk of addiction assessment signed by the patient and physician.

"Our program became a model for physicians and insurers across the country, leading to collaborative efforts that contributed to the promising trends detailed in this report," said Dr. Nash. "However, we know hard work remains. A survey conducted by Blue Cross Blue Shield of Massachusetts earlier this year found 1 in 4 people in our state know someone who has died of an opiate overdose. The health care community, regulators, law enforcement and advocates for those impacted by the opioid crisis must continue to work together to ensure opioid-based medications are appropriately prescribed and that those with opioid use disorder have access to effective treatment."

Other findings

Massachusetts and Rhode Island led the nation in meeting federal recommendations for opioid-based prescriptions. The Centers for Disease Control recommends opioid-based prescriptions contain less than 50 morphine milligram equivalents per dose and last for less than eight days. The Health of America report shows that in Massachusetts and Rhode Island, 57 percent of prescriptions followed these guidelines. The national average was 45 percent.

In an indication of the continuing seriousness of the epidemic, Massachusetts and the five other New England states showed rates of diagnosis of opioid use disorder (OUD) higher than the national average of 5.9 per 1,000 Blue Cross Blue Shield members. In Massachusetts, the rate of diagnosis was 7.0. New Hampshire had the highest rate of diagnosis at 12.3.

"People are still dying," said Ken Duckworth, MD, medical director, behavioral health. "The introduction of fentanyl, which is 100 times more powerful than morphine, social stigma, and access to treatment are among the challenges we must continue to address."

State                      2017 Diagnosis of Opioid Use Disorder/1,000 members

New Hampshire                                        12.3

Connecticut                                                 9.0

Rhode Island                                               9.0

Vermont                                                       7.9

Massachusetts                                            7.0

Maine                                                           6.5

National Average                                       5.9

About the Health of America Report

This is the 22nd study of the Blue Cross Blue Shield, The Health of America Report series, a collaboration between Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into healthcare affordability and access to care.

The report examines the medical and pharmacy claims of more than 41 million Blue Cross Blue Shield commercially insured members per year from 2013 to 2017. Members with a diagnosis of cancer or who are receiving services for palliative or hospice care were excluded. All other eligible members under age 65 were included in this analysis.

Prescription data was used to estimate raw opioid prescription counts and opioid prescription dose and duration. Prescription counts were treated equally regardless of the dosage or length of time of the prescription. Member-level dose and duration were calculated based on taking the average MME dosage and total prescription days for all prescriptions a member received within a calendar year.

Medical claims were used to measure the number of BCBS members with an ICD code-based diagnosis of opioid use disorder. Rates were computed on a per 1,000 member basis or percentage basis, where noted.

For more information and to read past reports from The Health of America Report series, visit https://www.bcbs.com/the-health-of-america/reports.

About Blue Cross Blue Shield of Massachusetts 

Blue Cross Blue Shield of Massachusetts (bluecrossma.com) is a community-focused, tax-paying, not–for–profit health plan headquartered in Boston. We're the trusted health plan for more than 25,000 Massachusetts employers and are committed to working with others in a spirit of shared responsibility to make quality health care affordable. Consistent with our corporate promise to always put our 2.8 million members first, we're rated among the nation's best health plans for member satisfaction and quality. Connect with us on Facebook, Twitter, YouTube, and LinkedIn.

About the Blue Cross Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. BCBSA provides health care insights through The Health of America Report series and the national BCBS Health Indexsm. For more information on BCBSA and its member companies, please visit BCBS.com. We also encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out our blog.

About Blue Health Intelligence

Blue Health Intelligence (BHI) is the nation's premier resource for data-driven insights about healthcare trends and best practices, promoting healthier lives and more affordable access to safe and effective care. BHI leverages a team of analytics experts and advanced technology, coupled with access to the greatest number of healthcare claims—172 million lives—gathered over 10 years in a safe, HIPAA-compliant, secure database. The resulting conformed, reliable data set has the broadest, deepest pool of integrated medical and pharmacy claims, reflecting medical utilization in every ZIP code. Blue Health Intelligence (BHI) is an Independent Licensee of the Blue Cross Blue Shield Association. BHI is a trade name of Health Intelligence Company, LLC. www.bluehealthintelligence.com

SOURCE Blue Cross Blue Shield of Massachusetts