Blue Cross Blue Shield SC addresses Opioid Epidemic

From Blue Cross on February 1:

As our state and nation mobilize to address the opioid abuse epidemic, BlueCross BlueShield of South Carolina is committed to doing its part. Starting April 1, 2018, new limits on opioid prescriptions will take effect for all employer groups with BlueCross pharmacy benefits.

We work with an independent panel of BlueCross network physicians and pharmacists, the Pharmacy and Therapeutics Committee, to develop and maintain our drug lists and policies. Clinical decisions are based on drugs’ efficacy, safety and value, with the goal of providing the greatest clinical effectiveness for the lowest cost.

Addressing opioid prescriptions specifically, the committee has focused on daily quantity limits and added requirements for prior authorization in some prescribing situations, basing its decisions on guidance from the federal Centers for Disease Control and Prevention.

According to the CDC, there were a record 33,000 U.S. deaths from opioid overdoses in 2015 — nearly half of them involving prescription medications. In 2016, nearly 5 million opioid prescriptions were filled in South Carolina, according to the S.C. Department of Health and Environmental Control.

“There is evidence that the more opioids are prescribed in a given region, the more likely it is that there will be a related increase in addiction and in overdose deaths,” said Dr. Matthew Bartels, BlueCross vice president and chief medical officer. “As this epidemic is addressed at the federal, state and local levels, we are hopeful that our new Opioid Management program will be part of the solution in South Carolina.”

Employers will not be able to opt out of the program. However, patients who have sickle cell disease, are undergoing cancer treatment, or are receiving palliative care or end-of-life care, will be exempt from the program requirements.

For details, please see this Update Bulletin on opioids from our Pharmacy Management department.

Attached to the policy bulletin about opioids is the regular Pharmacy Management Update Bulletin outlining some other drug list revisions. In particular, please note the coverage update affecting medications used to treat hepatitis C.