PA Health Insurer Highmark Enacts Strict New Limits On Painkillers In Effort To Reduce Prescription Opioid Abuse

Prescription Opioid Abuse | Just Believe Recovery PA

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PA Health Insurer Highmark Enacts Strict New Limits On Painkillers In Effort To Reduce Prescription Opioid Abuse

Health insurer Highmark recently announced that it would use analytical tools to assist Pennsylvania physicians in increasing the treatment safety of pain patients and help identify persons who are suffering from prescription opioid abuse.

The insurer will enact 7-day restrictions on opioid prescriptions for patients with work-based coverage and who have not been using opioids in the recent past. They will also limit members to 14 days of opioids per month. Highmark will also require an additional authorization before patients can receive extended-release formulations of opioids.

Highmark has collaborated with the firm axialHealthcare to provide doctors data and electronic tools to help them safely manage patient pain, including alternative forms of treatment such as physical therapy and help those who are abusing opioids.

Officials from the insurer stated the new policy to limit prescriptions “is completely about the safety of our members and the communities that we serve.”

One Highmark official told The Pittsburgh Post-Gazette, however, that the insurer won’t just cut off patients who have already been on high doses, noting that these patients often turn to illicit opioids such as heroin.

Highmark also states that the limits will not apply to patients who require opioids to control severe, long-term pain from conditions such as cancer.

The new tools will also query medical records to notify physicians of patients who may be at an increased risk of becoming addicted to opioids, under the assumption that these doctors will then offer alternative means to help control pain.

The insurer previously enacted some of these policies in West Virginia, and officials say that the number of members receiving painkillers from multiple doctors has fallen by 28%.

From a Highmark news release:

“Driven by analytics and supplemented by consultation with axialHealthcare’s licensed pharmacists, these tools will give providers insight into their own opioid prescribing patterns and guidance on clinical best practices for opioid prescribing, as well as provide access to patient safety alerts, care pathways for treating common pain complaints, and in-network referral support for complex cases that require personalized, high-quality care for pain or opioid misuse.”

~ G. Nathalee Serrels, M.A, Psychology


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