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. 1 A recent study of Aetna’s (NYSE: AET) 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:
- 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.
- 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.
- Becoming restricted to only one health care provider.
- Having reduced refill frequency and coverage.
- Getting referred to appropriate state and federal agencies.