Independence has made opioid abuse prevention and treatment a priority. The United States is in the midst of an epidemic of dependence and deaths related to the misuse and abuse of opioid drugs. According to the Centers for Disease Control and Prevention (CDC), 91 Americans die every day from an opioid overdose.¹ In 2014, Pennsylvania was ranked eighth in the U.S. for deaths related to drug overdose (21.9 per 100,000 people). In 2015, there was an increase of 23.4 percent for deaths related to drug overdose. At least one opioid was detected in approximately 81 percent of deaths related to drug overdose.² In support of our community, providers, and members, we have participated in the Mayor?s Task Force to Combat the Opioid Crisis in Philadelphia. Through that collaboration, we developed initiatives focused on prevention, treatment, and education related to opioid misuse and abuse.

Prevention: Initiatives to deter opioid misuse and abuse

Opioid use disorder often starts with appropriate use and later the abuse of prescription medications containing opioids. Studies show that one in four patients who are receiving long-term prescription opioid therapy in a primary care setting struggle with opioid addiction.¹ Independence has enhanced its opioid management strategy and is promoting several initiatives to decrease access to unused prescription opioids.

• For members with an Independence pharmacy benefit, the following initiatives support reduced risk of opioid use disorder and overdose:
• – Prior authorization is required for the following:
• all opioid products whose standard dosing exceeds 90 MED*;
• all opioid patches (as of July 1, 2017);
• most strengths of long-acting opioids.
• – As of July 1, 2017, Independence implemented a cumulative five-day supply per 30-day period for members newly initiated on an opioid (i.e., have not received an opioid within the last 30 days). If additional days? supply is required, a prior authorization will be needed. This applies to:
• all opioid products whose standard dosing is ? 90 MED* (e.g., ? 10 mg oxycodone IR);
• all opioid-containing cough and cold products;
• all butalbital products.
• – In cases of opioid management for chronic pain, the following are required:
• a Patient-Provider Agreement (view samples of a Patient-Provider Agreement online);
• annual prior authorization.
• Independence fully supports the new Pennsylvania Prescription Drug Monitoring Program, which requires providers to check whether patients are already using opioids before prescribing every time they prescribe and requires pharmacies to document purchases of opioids.
• Independence promotes the utilization of prescription drug take-back locations in southeastern Pennsylvania to decrease public circulation of prescription opioids.

Treatment: Initiatives to treat opioid use disorder

Independence has developed policies and expanded resources to help members with opioid use disorder. These include Medication-Assisted Treatment (MAT) and access to in-network providers who specialize in substance use disorder-related issues for members with an Independence behavioral health benefit.

• For members with an Independence pharmacy benefit, the following initiatives support treatment of opioid misuse and abuse:
• – Prior authorization was removed from all buprenorphine/naloxone products (e.g., Zubsolv^®, Bunavail^®) as of May 1, 2017.
• – As of July 1, 2017, buprenorphine products are available without prior authorization for a cumulative 180-day supply per rolling 365 days. A prior authorization must be requested if additional days? supply is needed within one year, in part to ensure the member?s participation in therapy.
• – Prior authorization is required when an opioid prescription is filled within two months of a paid claim of a MAT containing buprenorphine (e.g., Bunavail^®, Suboxone^®, Zubsolv^®, or Subutex^®).
• Medical benefits cover medications used to treat opioid use disorder, such as naltrexone (Vivitrol^®) intramuscular injection and buprenorphine (Probuphine^®) implant.
• For members with an Independence behavioral health benefit, the following are offered:
• – Access to providers, specialists, and therapists who specialize in substance use disorder. Members can use the Find a Doctor tool on our secure member website, ibxpress.com, to locate in-network providers.
• – Coverage for in-network substance use disorder detoxification and rehabilitation facilities to help members receive
  in-patient MAT and therapy to deal with their addiction issues.
• – Additional services, such as the provision and supervision of methadone hydrochloride.

For additional information on substance use treatment programs, members can refer to the mental health/substance abuse telephone number on the back of their ID card.

Education: Tools and resources for providers and members

Independence has put together informative tools and resources for providers and members as part of our ongoing commitment to opioid abuse prevention and treatment.

• An Opioid Awareness section is available on the home page of the Provider News Center that provides links to tools and resources to help providers manage patients who are prescribed opioid medications.
• Members can find a list of opioid and substance abuse materials, including useful information from the CDC, on the IBX member resources page.

*The following acronym is used to define the total daily dose of opioid converted to morphine equivalents: MED: Daily morphine equivalent dose in milligrams.

¹Rudd RA, Seth P, David F, Scholl L. ?Increases in drug and opioid-involved overdose deaths-United States, 2010-2015.? Centers for Disease Control and Prevention Morb Mortal Wkly Rep. Available at www.cdc.gov/mmwr/volumes/65/wr/mm655051e1.htm. Accessed March 21, 2017.

²Drug Enforcement Administration Philadelphia Field Division. ?Analysis of Drug-Related Overdose Deaths in Pennsylvania, 2015?. DEA Intelligence Report. Updated July 2016. Available at: www.dea.gov/divisions/phi/2016/phi071216_attach.pdf. Accessed July 6, 2017.