In the last two decades, prescribing rates for opioids have increased nearly three-fold, from 76 million prescriptions in 1991 to approximately 207 million prescriptions in 2013. This remarkable volume of opioid prescribing is unique to the United States, where 2015 prescribing amounts were nearly four times those in Europe. Sadly, this much more frequent prescribing of addictive medications is connected to an epidemic of deaths related to abuse of opiates and other drugs of abuse. Drug overdose deaths are now considered a national emergency, topping 59,000 in 2016. The abuse of opioids can be seen as the leading public health emergency in the United States faces today.
As the adverse consequences resulting from opioid misuse became apparent, employers sought the help of pharmacy benefit managers which responded by developing prospective (i.e., pre-dispensing) and retrospective utilization review programs to detect and intervene in unsafe prescribing of these addictive medications. Patients and prescribers who were engaged in unsafe behavior were identified and educated. Other interventions, in the form of member-specific drug limits, dispensing restricted to a single pharmacy, and prior authorization to ensure use for an appropriate diagnosis, were implemented – all programs shown to reduce opioid abuse. These programs had positive effects, but the magnitude of the opioid epidemic continued to increase.
Written by Troyen Brennan, Richard Creager, & Jennifer M. Polinski
