Opioid Addiction: Deaths Up, Blues Don’t Get It and John Oliver’s Take

BY SUSAN HAYES

 

My mother always said to be aware of things that come in three’s. I wonder what my mother would say about things that come in five’s. Five things just recently came together they made me think that now is a good time for a blog. I thought I had retired from blogging for a while. I mean with four jobs (Pharmacy Outcomes Specialists and Pharmacy Investigators and Consultants, Facilitating at Boston University for the Master’s program in Criminal Justice, and being a doctoral student at University of Portsmouth) who has time to blog?

So, the first thing to come along was that “The Angry Pharmacist” has resurfaced as a blogger. If you have not read “The Angry Pharmacist’s” blogs, you should (https://www.theangrypharmacist.com/), and if you have the ability to read four letter words and not be offended, then you will get a real appreciation of what our folks in white coats go through on a daily basis.  There were two things I learned.  Drug addiction is alive and well.  And, clearly, blogging about it made the Angry Pharmacist feel better.  Taking a dose of his/her medication, I decided to resurface my blogging.  Do not mistake the Angry Pharmacist blog with the Happy Pharmacist blog (https://thehappypharmacist.wordpress.com/) because if you do you will be very confused.

The second thing to happen was that I read that the Centers for Disease Control and Prevention issued statistics about opioid deaths.  The 2015 number of deaths due to opioid dependency. It is staggering. In 2014, there were 47,005 drug-related deaths in United States and 60% were due to opioid dependency. In 2015, there were 52,404 drug-related deaths due and 63% were due to opioid dependency (Rudd, et.al., 2016).  Nationally, the number of fentanyl and synthetic opioid deaths increased by 426% and 79%, respectively, during 2013–2014.  These findings, combined with the approximate doubling in fentanyl deaths during 2014–2015 (from 5,343 to 13,882), underscore the urgent need for a collaborative public health and law enforcement response (Gladden, 2016).  You think?

Indeed, opioid drug addiction is alive and well.  No letter reminders or compliance programs or Medication Therapy Management programs needed for the opioid category.  No sir, channeling the Angry Pharmacist, the screaming devil in your head is all you need to find that next dose of Oxy 80’s.  And if you are looking for a great retirement gig, you can buy 120 Oxy’s for $18 at Walmart (Website of Good Rx) and turn around and sell them for $80 a pill or $9,600 (Rubin, 2014).  You don’t get that kind of return on investment in your 401(k) program.

The third thing that made me really the Angry Pharmacy Benefits Consultant turned Fraud Investigator was the notice from Blue Cross Blue Shield of Illinois, Texas, New Mexico and Oklahoma (Health Care Services Corporation).  Apparently, The Blues have determined that there is no opioid crisis in America because they decided to TURN OFF THE PRIOR AUTHORIZATION (PA) REQUIREMENTS FOR OPIOID USE.  Yes, you read that correctly but if you don’t believe me, I have included the email I received about this change at the end of this blog (see Opioid Dependence Prior Authorization (PA) Program Changes) with the website listing.  So, maybe it was that fat rebate check from Purdue Pharma or maybe it was the Blues’ ineffective Prior Authorization program or maybe it cost too much to turn on PA’s for an $18 drug, but a PA process is really the only thing you can do as an insurance company to stop drug addiction of opioids before it starts AND YOU TURN IT OFF.  Then, you have the audacity to TURN ON a PA for opioid constipation (Movantik) and for Opioid Antidote (Evzio) (see https://www.bcbsil.com/PDF/rx/rx-um-programs-basic-enhanced-il.pdf).

Let me get this straight, Blue Cross Blue Shield of Illinois.  You think there is no need to prevent opioid drug addiction, but once your insureds/covered members are addicted, then the food in their stomachs can just rot because of constipation and when they overdose, THEY HAVE TO FINALLY CALL YOU TO GET the antidote.  Wow!  Did you just appoint Dr. Scrooge as your Medical Director?

The fourth thing is that my daughter sent me a link to John Oliver’s 20-minute diatribe on the Opioid epidemic in America.  She said I would enjoy it.  I did.  John, I don’t watch your show, but you are my kind of guy.  While somewhat lighthearted, Oliver is dead on (no pun intended) on his take on opioids in America.  Watch this and you will not wish you had the 20 minutes back:  https://www.youtube.com/watch?v=5pdPrQFjo2o

The fifth thing that happened is my nephew and his lovely family went on television this week to put a face to this tragedy.  Their honesty, bravery and struggles tell the story on a human level that CDC statistics and evil letters from insurance companies cannot.  Watch this and you will also not wish you had the five minutes back:  http://www.onenewspage.com.au/video/20170314/7053370/Recovering-Addicts-Read-Letter-From-Their-Toddler-Every.htm

The only “choice” there is about opioid addiction is the choice the medical practitioner makes to prescribe (or worse yet divert) opioids and to whom.  There is no choice about addiction just like there is no choice about diabetes, high blood pressure or cancer.  Let’s take the stigma away.  Let’s have insurance companies adopt rational programs for their members/insured and not for their own pocketbook.  And let’s find a way to, as the CDC implores, find collaboration to solve this blight on America with responsible public health, law enforcement and health insurer responses.

References

Gladden RM, Martinez P, Seth P. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid–Involved Overdose Deaths — 27 States, 2013–2014. MMWR Morb Mortal Wkly Rep 2016;65:837–843. DOI: http://dx.doi.org/10.15585/mmwr.mm6533a2

Rubin, S. (2014).  As Black Market Prices for OxyContin Soar, Local Youths Turn to Heroin.  Monterrey County Now, May 15, 2014.  Retrieved from http://www.montereycountyweekly.com/news/local_news/as-black-market-prices-for-oxycontin-soar-local-youth-turn/article_84a87bac-dbb2-11e3-8973-001a4bcf6878.html

Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:1445–1452. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1

Website of GoodRx.  Retrieved from https://www.goodrx.com/oxycodone?kw=price&utm_source=bing&utm_medium=cpc&utm_term=oxycodone|p&utm_campaign=oxycodone&utm_content=Ad-Group_General&utm_source=bing&utm_medium=cpc&utm_term=oxycodone&utm_campaign=oxycodone&utm_content=Ad-Group_General&mkwid=TjmZlQ0E&crid=15965383738&mp_kw=oxycodone&mp_mt=p

EMAIL FROM BCBSIL

From: @bcbsil.com]
Sent: Monday, February 27, 2017 3:51 PM
To:
Subject: FW: News from the Blues – Formulary Updates 4.1.17

 

Pharmacy Program Quarterly Update – Changes Effective April 1, 2017

Basic (formerly Standard) Drug List (Formulary) Changes
Based on the availability of new prescription medications and the Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some revisions will be made to the Blue Cross and Blue Shield of Illinois (BCBSIL) basic drug list, also known as a formulary, effective April 1, 2017.

Non-Preferred Brand1	Condition Used for	Generic Preferred Alternative(s)	Brand Preferred Alternative(s)1,2
Daklinza	Hepatitis C	N/A	Harvoni, Epclusa, Sovaldi

Performance Drug List (Formulary) Changes
Based on the availability of new prescription medications and the Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some drugs will be excluded from the BCBSIL performance drug list, also known as a formulary, effective April 1, 2017.

Non-Preferred Brand1	Condition Used for
Daklinza	Hepatitis C
Sitavig	Antiviral

Performance Select Drug List (Formulary) Changes
Based on the availability of new prescription medications and the Prime’s National Pharmacy and Therapeutics Committee’s review of changes in the pharmaceuticals market, some drugs will be excluded from the BCBSIL performance select drug list, also known as a formulary, effective April 1, 2017.

Non-Preferred Brand1	Condition Used for
Sitavig	Antiviral

Dispensing Limit Changes
BCBSIL’s prescription drug benefit program includes coverage limits on certain medications and drug categories. Dispensing limits are based on FDA-approved dosage regimens and product labeling.

Effective April 1, 2017, dispensing limits will be added for the following drugs on the Basic (Standard) Drug List and Performance Drug List:
Drug Class and Medication(s)1 – Dispensing Limit(s)

PCSK9 Inhibitors
Repatha 140 syringe – 2 per 28 days
Repatha 140 autoinjector – 2 per 28 days

Selective Serotonin Inverse Agonist (SSIA)
Nuplazid – 60 per 30 days

Therapeutic Alternatives
Doxepin 5% Cream – 45 grams per 180 days
levorphanol – 120 tables per 30 days
Vanatol LQ – 1000 mLs per 30 days
Vanos – 60 grams per 180 days

Misc.
Diclegis – 120 tables per 30 days
Rayaldee – 60 capsules per 30 days

Effective April 1, 2017, dispensing limits will be added for the following drugs on the Performance Select Drug List:
Drug Class and Medication(s)1 – Dispensing Limit(s)

PCSK9 Inhibitors
Repatha 140 syringe – 2 per 28 days
Repatha 140 autoinjector – 2 per 28 days

Selective Serotonin Inverse Agonist (SSIA)
Nuplazid – 60 per 30 days

Effective April 1, 2017, dispensing limits will be added for the following drugs on the Enhanced (Generics Plus) Drug List:
Drug Class and Medication(s)1 – Dispensing Limit(s)

Therapeutic Alternatives
Doxepin 5% Cream – 45 grams per 180 days

Standard Utilization Management Program Package Changes
NSAID GI Protectant Step Therapy (ST) Program Changes
Effective Jan. 1, 2017, the NSAID-GI Protectant ST program changed its name to: Combination GI Protectant. All targeted medications and program criteria remained the same.

Opioid Dependence Prior Authorization (PA) Program Changes
Effective Feb. 15, 2017, the Opioid Dependence PA program was discontinued.

PA and ST Program Changes Effective April 1, 2017
Effective April 1, 2017, several drug categories and/or targeted medications will be added to the PA program and ST program for standard pharmacy benefit plans, upon renewal for non-ASO groups. This includes ASO groups that have selected auto updates. For groups that have not selected auto updates, these programs will be available for selection beginning April 1, 2017. Contact your BCBSIL representative for more information.

Please note: As a reminder, the PA and ST programs for standard pharmacy benefit plans correlate to the member’s drug list. Not all standard PA and ST programs may apply, based on the member’s current drug list. A list of PA and ST programs per drug list is posted on the member prescription drug plan information section of bcbsil.com.

Drug categories to be added to the PA standard program (for members on the Basic, Performance or Performance Select Drug Lists), effective April 1, 2017:
Drug Category – Targeted Medication(s)1

Regranex – Regranex

Selective Serotonin – Nuplazid
Inverse Agonist (SSIA)

Strensiq – Strensiq

Targeted drugs to be added to current PA standard programs (for members on the Basic or Performance Drug Lists), effective April 1, 2017:
Drug Category – Targeted Medication(s)1

Therapeutic Alternatives – Doxepin cream, levorphanol, Vanatol LQ, Vanos

Drug categories to be added to the ST standard program (for members on the Basic, Performance or Performance Select Drug Lists), effective April 1, 20173:
Drug Category – Targeted Medication(s)1

Gabapentin ER – Gralise, Horizant

Insulin Combination Agents – Soliqua, Xultophy

Methotrexate Injectable4 – Otrexup, Rasuvo

Targeted mailings were sent to members affected by drug list deletions, dispensing limit and prior authorization program changes per our usual process of notifying members within 60 days prior to the effective date.

View the most up-to-date drug list and list of drug dispensing limits on bcbsil.com.

If you have any questions regarding these changes, contact your BCBSIL representative.

1Third-party brand names are the property of their respective owner.
2This list is not all inclusive. Other medications may be available in this drug class.
3Members on a current drug regimen will be grandfathered from participation in the ST program.
4Members on the Performance Select Drug List will not have this ST program applied to their benefit plan.

*These pharmacy changes apply to members and groups with prescription drug benefits administered through Blue Cross and Blue Shield of Illinois (BCBSIL).

BCBSIL contracts with Prime Therapeutics to provide pharmacy benefit management, prescription home delivery and specialty pharmacy services. BCBSIL, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics

Tags:

opioids

John Oliver

Blue Cross Blue Shield Illinois

opioid deaths

CDC