New Anthem Blue Cross Blue Shield Program Aims To Battle Drug Abuse

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New Anthem Blue Cross Blue Shield Program Aims To Battle Drug Abuse

Anthem Blue Cross and Blue Shield is debuting a new program that will identify members who abuse medications, and warn them to change their usage habits.

The Pharmacy Home Program analyzes the member data, and flags those who meet the criteria for a warning. Those warned about their drug misusing behavior will have 60 days to comply, or be required to choose just one pharmacy to fill all their prescriptions.

Spokespersons for Anthem state that the program was developed to address the increasing rate of prescription painkiller abuse and overdoses.

Many states currently have programs that monitor patient’s prescriptions (use of certain medications) prone to abuse. However, not all states require physicians to use the database, and many are not updated in real time.

According to research, after an overdose 90% of patients will receive more prescriptions for the very same medication they abused. What’s more, 70% will obtain that medication from their original healthcare provider.

The program’s purpose is to help prevent patients from doctor-shopping, or using multiple pharmacies to fill prescriptions. Those who received prescriptions from multiple providers would be flagged, as well as persons who may be using the emergency room for non-emergency health issues.

Once in the program, the member would be locked into one primary care doctor, one pharmacy, and one hospital.

Currently, Anthem already has similar program for several of its nationwide Medicaid programs.

The Criteria

Back in April, Anthem notified hundreds of members by mail. Each of these members, within a 90-day period, had been flagged for one or more of the following:

  • Filling 5 or more prescriptions for a controlled substance
  • Filling 20 or more prescriptions in total
  • Visiting 3 or more providers for controlled substance prescriptions or
  • Visiting 10 or more providers in total
  • Filling controlled substances at 3 or more pharmacies or
  • Filling prescriptions in total 10 or more pharmacies

Of note, members with specific diagnoses (i.e. cancer) known to cause chronic pain are exempt.

~ G. Nathalee Serrels, M.A., Psychology

Just Believe Recovery is a fully licensed, Joint Commission accredited, comprehensive drug and alcohol treatment center located in Carbondale, Pennsylvania

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