Prescription drug abuse is an epidemic in the United States with about 2.4 million Americans struggling with addiction to prescription painkillers known as opioids. According to the CDC, opioid addiction is a leading cause of death in the United States and adds $72.5 billion in expense to the health care system each year.
A recent study of Aetna’s (NYSE:
) programs designed to address prescription drug misuse, waste and abuse showed reduced opioid use among 4.3 million members by 15 percent between January 2010 and January 2012. These outcomes were unveiled at the Pharmacy Benefit Management Institute’s Drug Benefit Conference held February 18 – 20 in Las Vegas.
“We’re encouraged by the evidence that our misuse, waste and abuse programs are controlling access to drugs with high potential for abuse,” said Yrena Friedmann, Pharm.D., Director, Aetna Pharmacy Management. “We’ll continue to do our part to fight prescription drug abuse. We must remain vigilant for the health and safety of our members.”
How Aetna’s Misuse, Waste and Abuse Prevention Programs Work
Aetna’s programs identify when a member is accessing a drug in an amount that may be unsafe and safeguards to stop potentially dangerous situations. Aetna pharmacists work with members to ensure they get only the drug needed, in the right amount.
Aetna’s misuse, waste and abuse prevention programs work together in four phases to ensure member safety and offer support to those who need it.
1. Control –
Access to prescription drugs with high potential for abuse is controlled at the pharmacy by:
2. Find –
- placing a limit on how much of a drug is covered at a given time,
- verifying medical need before coverage of a drug is approved, and
- advising the pharmacist if a drug’s dosage amount appears unsafe.
Each member’s prescription drug history is reviewed before a new prescription is filled. This review allows patterns of frequent use or suspicious dispensing to be identified.
3. Help –
Extra support is offered to members who may be using a prescription drug unsafely. This includes:
4. Limit –
- Referral to a pain specialist.
- Encouragement to enroll in a pain management program.
- Referral to Aetna Behavioral Health for emotional support.
- Referral to Aetna Case Management for additional support.
Members who don’t respond to support when it’s offered
may have limited access to their prescription drug benefits, such as:
- Becoming restricted to only one health care provider.
- Having reduced refill frequency and coverage.
- Getting referred to appropriate state and federal agencies.
To learn more about how Aetna’s Pharmacy Management team is working to maintain member safety, visit
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 37.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see