Overuse of prescription pain medications, otherwise known as opioids, has reached epidemic levels in the United States. According to the Centers for Disease Control and Prevention, as many as one in four patients receiving long-term opioid therapy struggles with opioid misuse or addiction.

Premera recognizes that the opioid crisis is a complex social health issue. Our efforts to address the issue are centered on reducing the number of chronic opioid users and helping our customers with opioid use disorder get treatment.

As a large health plan, we’re actively involved in helping shape opioid prescribing policies and guidelines in Washington state though our involvement with the Bree Collaborative, a network of healthcare experts working to improve care quality and cost effectiveness. We’re working together with providers, mental health professionals and community resource agencies to attack the issue on multiple, coordinated fronts. Examples include:

• Prescription safety checks – promotes safe drug use by requiring drugs be reviewed and approved by Premera before they are covered
• Pain management coaching – customized outreach and coaching services from MOBE Health a program that works with customers battling chronic pain, encouraging them to seek care beyond medications and medical visits
• Premera Special Investigations – analyzing prescription claims data to identify providers prescribing opioids for long durations or high doses
• Claims data analysis – review claims to identify people filling multiple opioid prescriptions and also  identify new opioid users by age, duration and dosing levels to minimize long term use and dependence
• Provider reports – provide patient prescription information to doctors and dentists highlighting patients that are on potentially dangerous doses of opioids.

We’re inviting doctors to take a closer look at their prescribing habits and to have important conversations with their patients about their pain, and options for help. These may include office-based opioid treatment, non-opioid pain relievers, and alternative therapies like cognitive behavioral therapy and coaching, all of which Premera covers.

Within Premera, our medical directors, nurses, pharmacists, care managers and benefits experts are working closely to provide new insights into how we can help support our customers’ access to comprehensive treatment.

We recognize the growing need for treatment options that fit different lifestyles and individual needs.  The majority of our plans cover non-opioid pain medications, physical rehabilitation (like massage or physical therapy), cognitive behavioral therapy, health coaching, and other pain treatments. Premera also offers personalized support and coaching from registered nurses and licensed mental health professionals that can help them navigate their health coverage and find the resources they need.

One of the biggest barriers for people who have become dependent on these powerful drugs is the stigma of addiction and knowing where to turn for help.  We are able to provide information and point them to resources to help remove these barriers and make sure they get the care and treatment they need.

For example, a nurse on our care management team recently reached out to one of our customers struggling with opioid dependency who didn’t know where to turn for help when suffering from significant withdrawal symptoms. The nurse connected her with a doctor who prescribed Suboxone, a drug used to mitigate symptoms of opioid withdrawal. She also received information about counseling and mental health resources available to her through her Premera health plan.

In another example, we worked with a customer taking a significant daily dose of opioids to treat side effects from chemotherapy even though he had been cancer free for more than five years. We were able to steer the customer toward rehabilitation and today he is off opioids. Knowing the path for many, this intervention may literally have saved his life. 

We want our customers to know they’re not alone and that we can help. Watch our recent appearance on KING 5’s New Day Northwest for additional information on how to get help with chronic pain or a potential problem with opioids.

Shawn West, MD is a Medical Director in Premera’s Healthcare Services division and spends much of his time engaging with doctors and clinicians in our provider networks to help connect clinical practices with the operational and contractual aspects of care.