Contact Us Insurance Education      

“Super-Prescribers” are being Placed on Aetna Watchlist

Picture a bottle of opioid pills, such as oxycodone. Now think about 280 million bottles of opioid pills. That’s how many are given to patients annually. The actual number of pills given out per year is in the billions. In a society all too familiar with substance abuse, it seems no wonder we are in the midst of an opioid-abuse epidemic. Due to the epidemic, Aetna, a very large American health care company, has begun notifying those doctors who prescribe the most opioid pills (super-prescribers); they notified 951 of them in fact.Aetna Watchlist Super-Prescribers

The Facts

The near-thousand doctors notified made up the top 1% of opioid prescribers, now being called super-prescribers. Over 8.5 million insurance claims were analyzed, and only doctors who had prescribed opioids a dozen or more times were included. Had these doctors prescribed at the average rate, nearly 1.5 million less opioid pills would be in public hands. Granted, the vast majority of the patients given opioids needed them medically, but still, plenty of the drugs end up in an abuser’s hands. Not to mention, doctors who routinely prescribe large amounts of opioids were excluded.

Aetna sent the same message to each and every doctor: “You have been identified as falling within the top 1 percent of opioid prescribers within your specialty.” This simple sentence is not a warning so much as a strong suggestion to ensure all opioid prescriptions are necessary. High refill rates may be needed in some cases, but without a doubt some refill rates could stand to be curbed or even ended. 14,838 people died from opioid overdoses in the year 2014 alone.

The Reasons

Harold Paz is the chief medical officer of Aetna. Speaking to the Washington Post, but really speaking to the doctors on the Aetna watchlist, Paz said, “We’re asking you to look at your practice…and identify if the way you’re prescribing narcotics is best practice. And if it’s not, here’s an opportunity to improve.” Nothing criminal is suspected of happening.

This is simply a major step being taken by an insurance provider to help try and end the opioid crisis. According to a recently published article by Journal of the American Medical Association, almost 60% of us leave our leftover prescriptions at home once done with them, and 20% of us give them away. This game of telephone with drugs needs to stop. Please if you’re reading this, do not share your prescription pills and in fact keep them well hidden. If you no longer need them find out how to properly dispose of your excess drugs.

Aetna is not alone in this battle. Other insurance companies have launched similar campaigns to help stop the abuse. Consumers for Affordable Health Care believes lowering the opioid prescription rate will even benefit the insurance companies themselves. This is because the medicine is expensive but also because overdoses lead to other diagnoses that are also expensive. Yes, it may also be about money with the insurance companies, but nevertheless the morals are in the right place.

Cigna, another rather large insurance provider, currently has programs to reduce opioid prescriptions. Their goal is to lower the rate by 25%. Anthem, another insurance company, launched the Pharmacy Home Program, which aims to reduce the amount of people who attempt to receive multiple prescriptions from multiple doctors and therefore receive multiple bottles of pills. This is known as “doctor shopping” and is punishable by law.

The Hope

We can only pray that somehow the opioid abuse problem in America stops. This is a good thing that Aetna and other insurance companies are doing, but it will not stop the problem by itself. Education on drug abuse at early ages and a whole lot of human help is required, but it is not impossible.

 
Help