Segment 2: Combating Opioid Abuse

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Collaboration among multiple stakeholders is needed to address the problem of nonmedical use of opioids. Access to state-level data would help payers obtain a fuller picture of the prescriptions being acquired by members, remarks Jeffrey Dunn, PharmD, MBA. Allowing payers to access data from state prescription drug monitoring programs (PDMPs) would help, concurs Peggy Johnson; however, not enough physicians use PDMPs and, thus, the data are insufficient. There is an opportunity for payers to help encourage physicians in their networks to use PDMPs, to help address this obstacle.

Burton VanderLaan, MD, FACP, Dunn, and Johnson describe the advantages of a patient-centered medical home (or team-based approach), which allows an integrated, comprehensive, coordinated approach for identifying, monitoring, and managing individuals susceptible to abuse. Also, many payers have monitoring programs offering members access to other types of resources, such as care management, mental health, and social workers.

At the federal level, the National Drug Control Strategy is based on 4 policy pillars. The first pillar includes educating prescribers regarding risk stratification and appropriate prescribing practices, as well as educating consumers and caregivers about how to manage prescription medications. Another pillar is the individual monitoring of a patient’s progress—with each prescription, the patient’s need for medication should be re-evaluated. When medication is no longer needed, a route for safe disposal is needed; disposal is the third pillar of the federal strategy. There are DEA and state-sponsored drug take-back days, and the prescribing information and medication guides for most opioids include instructions to flush unneeded medicine down the toilet. An appropriate disposal mechanism is needed to avoid having leftover medicines in medicine cabinets. The last pillar is the enforcement of existing laws and regulations.

The Office of National Drug Control Policy (ONDCP) requested that the FDA provide an expedited review of new drug applications for a drug with a known abuse potential that’s being presented in a formulation designed to deter one or more methods of abuse or a new molecular entity with reduced or no abuse potential. The ONDCP also requested that the FDA provide guidance to industry regarding the development and evaluation of abuse-deterrent formulations. Final guidance on the evaluation and labeling of abuse-deterrent formulations was released in April 2015. Similar draft guidance on generics with abuse-deterrent properties will be issued for generic drug producers.

Although some payers have adopted payment models that provide reimbursement for services such as screening and assessment, there is an opportunity for additional integration of, and reimbursement for, these services. Better data are needed demonstrating that changes in reimbursement impact behavior, lower costs, and improve outcomes.