Blue Cross Blue Shield of Massachusetts is taking a measured step to curb the abuse of prescription painkillers by limiting the amount of medication a patient can receive without the insurer’s prior approval. There is some concern that the plan could inconvenience legitimate sufferers and burden busy doctors with extra documentation. But on balance, this is a carefully crafted approach that other health plans would do well to duplicate.
The Centers for Disease Control and Prevention has identified the abuse of prescription painkillers as a national epidemic marked by more overdose deaths each year than heroin and cocaine combined. Opioid painkillers, such as OxyContin and Vicodin, are easily diverted from the home medicine cabinet to the illegal market. And many drug-seeking patients are expert in so-called “doctor shopping’’ — obtaining multiple prescriptions from multiple doctors.
Blue Cross Blue Shield of Massachusetts didn’t rush into this decision. It was made in consultation with an independent panel of pain and addiction experts, and not with an eye toward cost containment, which will be marginal. The insurer, therefore, should be commended for attacking the supply side of the painkiller problem, even at the risk of alienating powerful medical societies.
Starting in July, the insurer will limit its no-questions-asked reimbursement to a 30-day supply of powerful opioid painkillers. After that, Blue Cross will insist that physicians get informed consent from patients regarding the risks of taking painkillers, including addiction. The insurer also will require that prescriptions originate from only one prescribing group of doctors and get filled at only one pharmacy or chain of pharmacies.
Cancer patients or those with terminal illnesses that require longterm pain management will be exempt. The effort is aimed instead at physicians who have become too casual about writing prescriptions for powerful narcotics when their patients’ pain could be managed with less addictive medicines.
Physicians aren’t really in a position to complain given how little they have done as a group to prevent the abuse of painkillers. Only a small fraction of Massachusetts physicians, for example, has enrolled in an online prescription database created by state health officials to prevent doctor shopping. One might expect more on the part of a profession that doubled the number of prescriptions written for narcotic painkillers in the last decade.
“Somebody has to call the question,’’ said Dr. John Fallon, Blue Cross’s chief physician executive. And who better to do that than the state’s largest private medical insurer? Hospitals and doctors should do all they can to make the new system work.