Blue Cross Blue Shield Cracks Down on Prescription Opiate Abuse

A new policy announced by Blue Cross Blue Shield (BCBS) will go into action in July and has physicians in Massachusetts divided on its necessity and practicality. The company has set new guidelines for the prescription of powerful opiate painkillers that are often implicated in the rising prescription drug epidemic. BCBS is Massachusetts’s largest insurer and so many doctors will be affected by the new procedures that will soon be put in place.

A Number of Changes Will Be Made to Painkiller Prescription Policy

BCBS has implemented the following changes to the way prescription medications will be dispensed if an individual wants their plan to cover the costs:

  • Patients will be allowed a 15-day prescription and a 15-day refill for short-acting opiate pain medications, such as Percocet and Vicodin.
  • Any refills beyond 30 days will need authorization from the insurance company.
  • The same doctor and pharmacy must be used in order to receive the prescription refills. This is to ensure that the individual is not a prescription drug addict receiving multiple scripts from multiple providers.
  • The policy also addresses long-acting pain drugs such as OxyContin, one of the most addictive prescriptions on the market. In order to obtain such potent painkillers, from now on BCBS will require a pre-authorization from the start.
  • Physicians would also have to document that they have explained the potential dangers of addiction with patients who take prescriptions past the 30-day mark.

BCBS set the cut-off mark at 30 days because research is now showing that the likelihood of developing an addiction to prescription pain meds jumps significantly for patients using opiate drugs beyond that point.

New Policy Is Intended to Provide Pain Relief While Stopping Abuse

There is a mixed reaction from healthcare providers regarding the upcoming changes in BCBS’s prescription drug rules. Some physicians are relieved to see more safeguards being instituted to protect their patients from addiction while others feel it is just more red tape that stops them from freely doing their job. Knowing these new rules would be prohibitive and unnecessary for certain populations, the policy makers tried to take certain scenarios into account. For example, those suffering from terminal illness such as cancer are excused from the new guidelines.

Do you think insurance companies should be involved in trying to reduce prescription drug abuse? Or do you think that should be left to doctors, legislators and law enforcement? Let us know your opinion below and leave a comment.