Advanced Opioid Management Program Focuses on Recovery and Abuse Prevention

Our nationally recognized Advanced Opioid Management program gives employers new tools to help prevent abuse and guide workforce members in need through a successful recovery.
Opioid recovery and abuse

As Ben Franklin famously said, “An ounce of prevention is worth a pound of cure,” and nowhere is that axiom more true than in addressing opioid use disorder.

Educating patients on safe opioid medication use, starting patients off on the safest quantities and types of opioid medication, and making safe disposal of opioids easy, are the cornerstone of our industry leading Advanced Opioid Management program, which aims to help prevent the use of opioids medication from turning to opioid use disorder.

Our comprehensive approach is yielding positive results.

93% of patients prescribed an opioid for the first time will start with a 7-days’ supply or less. Since September 2017, when we implemented this protocol, we have kept 1.4 million days’ supply of opioids from being distributed to patients without compromising access to necessary pain relieving therapy. Fewer opioids in circulation helps reduce improper use of opioids that can lead to opioid use disorder.

Our Advanced Opioid Management Program has been designed to align with the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (outside of active cancer treatment, palliative care, and end-of-life care.) The guideline provides guidance to physicians regarding:

  • When to initiate or continue opioids for chronic pain
  • Opioid selection, dosage duration, follow-up, and discontinuation
  • Assessing risk and addressing harms of opioid use

Express Scripts is the first in the industry to address potential behavior and safety gaps at each touch point, and it is essential that we continue to work across the care continuum on behalf of our clients and members.

Behind the data and behind the statistics of the opioid epidemic, the pharmacists and care teams in our Neuroscience Therapeutic Resource Center® (TRC) are touching lives and making a difference, one patient and one prescription at a time. These pharmacists work every day to get patients on a path toward safer use of opioid medication through the hundreds of hours of conversations they are having with patients about opioid risks and safe disposal.

Our program, along with other proactive solutions, are offered to our clients to help address the nation’s opioid epidemic, which, in addition to the tragic human toll, has had an economic toll on U.S. employers of more than $18 billion.

From Prevention to Cure

Since implementing our Advanced Opioid Management program less than two years ago, we’ve continued to identify ways to provide the strongest program possible for our clients and their members. The more we’ve studied opioid use disorder and its effect, three things are clear:

  • Recovery is possible, but it must be made a serious priority
  • Vulnerable patients should be protected even before their first refill
  • Employers can play a critical role in helping patients achieve successful recovery

With this in mind, we’re adding new, recovery-focused enhancements to our Advanced Opioid Management program – at no extra charge to enrolled clients, effective Sept. 1.

These enhancements include:

  • Recovery assistance: Outbound phone calls from our TRC pharmacists to support members on Medication-Assisted Therapy (MAT). MAT is the use of anti-craving medicine to help address issues related to opioid dependence. It is the most effective way to combat opioid addiction, yet just one-third of patients who need it actually use it.

We’ll also bring additional awareness to patients by providing addiction, mental health, and suicide hotline resources on select member-facing materials.

  • Point-of-Care Protection: Additional physician care alerts for patients with mental health prescriptions.
  • Prenatal Protection: Additional physician care alerts for patients with a prenatal vitamin prescription and an opioid prescription.
  • Abuse Prevention with Point-of-Sale Strategies: Initial fill days’ supply rule for adults initiating opioid therapy are limited to a 7-days’ supply for members’ first 4 fills, requiring a prior authorization to exceed 28-days’ supply in a 60-day period.

In addition, we are limiting the morphine equivalent dosing to 90 morphine milligram equivalent (MME) for patients starting on opioids. Existing users are limited to 200 MME, unless they receive a prior authorization for a higher dosage.

We’re also implementing initial fill days’ supply rule for pediatric patients. For these patients, we’re limiting opioid therapy to a 3-days’ supply for each of their first 4 fills, requiring a prior authorization to exceed 12-days’ supply in a 60-day period.

Meaningful Impact and Influence Across the Care Continuum

These enhancements bolster an already robust program with proven impact for our clients’ members and their families. Our solution maximizes safety across the care continuum, shielding clients and their members by minimizing early opioid and adjacent therapy exposure, as well as encouraging treatment and recovery for those patients already suffering from opioid use disorder.

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