Pharmacy benefit managers target opioid crisis

An open bottle of prescription painkillers. (Photo illustration: Leigh A. Williams)

According to the Centers for Disease Control and Prevention, roughly 249 million prescriptions for opioids were written in 2013 — enough for every American adult to have a bottle of pills. A separate government analysis found that of the estimated 50,000 Americans who died from drug overdoses in 2015, more than 33,000 of the deaths involved opioids.

Nationwide, the opioid epidemic has reached crisis proportions, and is costing the United States more than $500 billion annually.

Though California did become one of the first states to require pharmacies to conduct an inventory of schedule II drugs every 90 days, the state is not immune to this crisis, with more than 4,600 victims in 2015 of drug-overdose deaths, a “trend primarily driven by opioids.”

All states now permit the use of e-prescribing for controlled substances and an increasing number of states require its use.

While this crisis is ravaging local communities, policymakers are attempting to find solutions that can help stem the tide.  As sophisticated health care companies with a long history in reducing medication errors and promoting appropriate use, America’s pharmacy benefit managers (PBMs) are advocating policy solutions that can improve patient safety and also lower health care costs.

One critical step championed by PBMs is requiring electronic prescribing (e-prescribing) of controlled substances in Medicare. E-prescribing of controlled substances helps ensure each prescription is written by a legitimate prescriber and filled by a legitimate pharmacy.

According to a recent study on e-prescribing of controlled substances, the technology promotes patient safety because these systems have access to comprehensive medication history, which can check for allergies to the proposed medication and drug interactions, thus preventing adverse drug events.

In addition, having access to a comprehensive medication history helps prevent prescriber and pharmacy shopping, enables better prescription tracking, and reduces overall fraud. All states now permit the use of e-prescribing for controlled substances and an increasing number of states require its use.

Electronic prescribers of controlled substances must also meet the computer security requirements established by the Drug Enforcement Administration, ensuring that information systems are in place that protect patient information and prevent fraud in the prescribing of drugs.

Another policy solution PBMs support to reduce opioid abuse is improving and integrating state Prescription Drug Monitoring Programs (PDMPs) and requiring prescribers to check them prior to issuing a controlled substance prescription.

State governments should also make their PDMP databases more easily accessible, more user-friendly, available in real time, accurate and better integrated across the country. 

As the home of technology innovation, California should adopt these critical lifesaving tools that improve patient safety and save lives.

By advocating for these policies, PBMs are taking an active role in helping address the opioid crisis.

Ed’s Note: John D. Jones, RPh, JD, FAMCP is an expert on managed care pharmacy practice, pharmacy law, regulation and policy. He teaches Pharmacy Law and Ethics at multiple colleges of pharmacy in California.


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