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Pharmacy Benefit Managers and the Fight Against Opioids

Pharmacy Benefit Managers and the Fight Against Opioids

By    |   Thursday, 16 January 2020 11:42 AM

The major public health issue in the United States today is the opioid crisis.

Over the last decade, there have been more than 700,000 people who have lost the battle against their addiction to opioids. In 2019, the National Institutes of Health (NIH) reported that 130 Americans die due to opioid misuse every day.

What is the Opioid Crisis?

Since the 1990s, there has been an increase of opioid prescriptions, without the knowledge of how addictive these drugs are. This has led to widespread misuse of both prescription and non-prescription opioids, which has fueled a nationwide addiction. Unfortunately, from 2016 to present, there has been a spike in deaths due to overdose as well as a rise in the use of heroin and heroin overdoses, as opioids serve as gateway drugs. This transition from opioids to heroin happens because street drugs are significantly less expensive than prescription drugs. Once one becomes addicted to opioids, the only inexpensive avenue to achieve the same high are street drugs, like heroin.

What Role Do PBMs and MC-Rx Play?

Following the rise of overdoses, the Centers for Disease Control and prevention released a set of guidelines for opioid prescriptions that became the national standard. As a PBM, MC-Rx uses this standard as a guideline for how we work with employers and patients. We evaluate potential risk based on the population, and we administer Morphine Milligram Equivalent (MME) dosing protocols with seven-day initial fill limits for patients with acute pain needs.

However, despite having these safety standards in place, it is going to take more than just PBMs to solve the opioid crisis.

How Do We Fight It?

To combat and prevent new and chronic opioid abuse, a holistic approach is required, including collaboration among insurers, PBMs, governmental agencies, and others.

As the Executive Vice President of MC-Rx, I understand the position of power that we have to assist in the fight against this crisis. Since almost 100% of every opioid prescription processed under insurance will adjudicate on a PBM system, we have access to a significant piece of the puzzle that allows us to engage with these claims in real-time. About half of US businesses are using their PBMs to reduce claims involving opioids.

The National Business Group on Health has even strongly encouraged a partnership between PBMs and employers across the country. They recommend that businesses communicate with PBMs to find unusual patterns of employee opioid use. Employers must help protect employees from opioid dependence by offering a structured and custom benefit plan that is designed to limit the access to a minimum necessary treatment regime and dosage.

We must not only support the effort to prevent and decrease the number of people who are dependent on opioids, but we must also facilitate efforts to create prevention mechanisms. With the partnership of insurers, PBMs, and governmental agencies, this can be achieved, as there must be a national collaboration between these groups.

PBMs are committed to doing what is best for their clients and for their patients. We want to fight for physicians and pharmacists to allow them to treat patients to the best of their ability, including fighting against this epidemic and creating a world where we can manage patients’ pain in a meticulous and measured way.

LaMar Williams is the executive vice president at MC-Rx, a full-service Pharmacy Benefit Manager (PBM) with corporate offices in Gainesville, Georgia and Caguas, Puerto Rico.

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The major public health issue in the United States today is the opioid crisis.
pharmacy, benefit, managers, opioids, pbm
Thursday, 16 January 2020 11:42 AM
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