In a move to combat the nation’s opioid crisis, Aetna announced that it will waive copays for Narcan for its fully-insured commercial members starting in January.
The current copay for Narcan, which is used to help a person overdosing on opioids, is between $0 and $150, but usually falls between $30 and $40, said Aetna.
Aetna will also limit opioids prescribed for acute pain and post-surgery patients to a seven-day supply for its commercial pharmacy members.
Aetna is hoping that waiving the copay for Narcan will improve prescription pickups. The payer found that many members prescribed Narcan don’t pick up their prescriptions. This was the case for almost 35% of its members prescribed the drug between January and June of this year. Aetna said research shows that its members are less likely to fill Narcan prescriptions if they must pay higher copays. There is a 76.7% prescription abandonment rate if the copay is between $100.01 and $150 and 46.1% if the copay is between $40.01 and $50.
“Cost is clearly a factor in whether individuals with substance abuse disorder obtain medication that could save them from a fatal overdose,” said Dr. Harold L. Paz, executive vice president and chief medical officer at Aetna. “By eliminating this barrier, we hope to keep our members safe until they are ready to address their addiction.”
Aetna hopes that the other piece of its initiative — limiting opioid prescriptions to seven days for first-time prescriptions — will reduce supply and potential for dependence on the drug.
Six percent of people who receive a one-day supply of opioids for acute pain still take opioids a year later. That increases to 13.5% for people who receive a prescription for eight days or more and to 30% for those prescribed 30 days or more, according to the Centers for Disease Control and Prevention.
The new initiatives are the latest by Aetna in the fight against the opioid epidemic. Previously, Aetna ended preauthorization requirements for commercial members on all buprenorphine products in March.
Aetna has five-year goals to reduce opioid usage and abuse by 2022, including reducing inappropriate opioid prescribing by 50%, increasing members with chronic pain treated by an evidence-based multimodal approach by 50% and increasing the percentage of members with opioid use disorder treated with medication-assisted therapy and other evidence-based treatments by 50%.
Aetna is one of many healthcare stakeholders and state and federal officials striking the alarm on the opioid crisis:
- Anthem said recently it had reached its goal of reducing filled opioid prescriptions by 30%.
- Cigna achieved a 12% reduction in customer opioid use.
- Intermountain Health recently set a goal of reducing opioid prescriptions 40% by the end of next year.
PricewaterhouseCoopers' Health Research Institute named the opioid crisis as one of its top issues for the healthcare industry in 2018. A report from the White House Council of Economic Advisers (CEA) said the cost of the opioid crisis in 2015 totaled $504 billion. In October, President Donald Trump declared the opioid crisis a public health emergency, which offered a spotlight on the crisis, but not the funding needed to combat the issue.
Though healthcare stakeholders have highlighted the problem, a September report from ProPublica and The New York Times found that Medicare is restricting access to safer, less-addictive alternatives to opioids. The report said Medicare drug plans that cover lidocaine patches, which are a safer alternative, require prior approval for the patches. Patients usually don’t face that hurdle when it comes to common opioids.
At that time, the National Association of Attorneys General sent a letter to Marilyn Tavenner, president and CEO of America’s Health Insurance Plans (AHIP), on the topic. The organization asked AHIP to encourage its members to review and revise policies to prioritize non-opioid pain management when appropriate. Insurance companies are in a position to help relieve the opioid crisis by incentivizing providers who "will often favor those treatment options that are most likely to be compensated," according to the group.
Around that same time, AHIP launched a program called the Safe, Transparent Opioid Prescribing (STOP) Initiative that looks to collaborate with state and federal leaders, physicians and other providers on ways to address the crisis. The STOP Initiative supports adoption of clinical guidelines for pain care and opioid prescribing.