Payers & Abuse Deterrence

Inadequate treatment of pain and abuse of prescription pain medications are both serious public health problems that are increasingly at odds in our society. For many years, Purdue has committed substantial resources to combat opioid abuse and support the responsible use of Rx opioids.

Purdue is dedicated to being part of the solution to reduce the abuse of prescription opioid medications. For many years, Purdue has funded programs and provided resources to support the responsible use of prescription opioids. These efforts include combating opioid abuse by partnering with healthcare professionals, patients, caregivers, communities, law enforcement, and government. In addition, Purdue has led the development of opioids with abuse-deterrent properties.

The healthcare community has stepped up to the challenge of reducing Rx opioid abuse, misuse, and diversion in several ways. For example, healthcare professionals who prescribe opioid analgesics invest valuable time on patient screening and monitoring, more use of patient agreements and patient counseling, watch for red flags that alert them to doctor or pharmacy shopping. Many of these healthcare professionals also participate in the Risk Evaluation and Mitigation Strategy (REMS) program for extended-release and long-acting (ER/LA) opioid analgesics.

In addition, several professional healthcare associations and patient advocacy organizations have been developing positions and policies to address the problem of prescription drug abuse, including support for emerging technologies in opioid abuse deterrence. In recent years, payers have also taken action to support the deterrence of prescription opioid abuse.

Payers Are Taking an Active Approach in Deterrence of Opioid Abuse

Commercial plans have been helping their members address pain management and/or substance abuse issues. In recent years, payers have also focused on detecting and stopping the diversion and abuse of opioid pain medications.1 For example, a health insurance plan in Tennessee introduced its RxSafeguard program that partners with prescription benefit managers (PBMs) to analyze claims for red flags that may indicate “doctor shopping” by members or inappropriate prescriptions written by healthcare professionals.1

Purdue welcomes partnerships with payers to collaborate on new ways to reduce the diversion, misuse, and abuse of Rx opioids.

To request a meeting with a Purdue Managed Care Regional or National Account Executive (RAE/NAE) to discuss recent government and health plan initiatives concerning abuse deterrence or FDA Guidance on opioids with abuse-deterrent properties:

Purdue Supports Prescription Drug Monitoring Programs

“Doctor shopping” is a term used to describe a common scam drug seekers use to obtain prescription medications for abuse or for sale on the street. A doctor shopper will visit several doctors in order to obtain multiple prescriptions for the same medication. The physicians think that they are treating a legitimate medical condition and are unaware that the “patient” is visiting other prescribers.

For more than a decade, Purdue has supported Prescription Drug Monitoring Programs (PMPs) by working with state legislators, regulatory agencies, professional organizations, and by providing funding to the National Association of State Controlled Substances Authority (NASCSA). To date, 49 states have established or are developing PMPs to track prescriptions for controlled substances. Prescriptions are captured in a database after the medication is dispensed. Healthcare professionals can check the database to see if a patient has recently obtained prescriptions from another prescriber. Law enforcement officials, under special circumstances, can obtain permission to check the database as part of an investigation.

Purdue also provided a seed grant to the National Association of Boards of Pharmacy (NABP) to establish PMP InterConnect, a system to help states share prescription data with one another to help deter doctor shopping across state lines.

Although PMPs can be a valuable tool to spot doctor shopping, it is important that they protect patient privacy, do not impede patient care, and protect healthcare practitioners from inappropriate or undue interference.

Reference: 1. AISHealth. Health insurers get increasingly active in programs to deter, stop abuse of opioids. Health Plan Week. 2014;24(24):1-8.