November 15, 2018
Premera is expanding its capacity to investigate claims patterns that often signal opioid abuse and fraudulent behavior starting January 1, 2019. Working with Express Scripts, Premera will identify members whose claim patterns for controlled substances and opioid prescriptions indicate a potential problem. Indicators include:
- Claims for controlled substances from multiple providers
- Use of multiple pharmacies to pick up these prescriptions
- Distance traveled to providers and pharmacies
Premera will have the ability to “lock” these members into using a single pharmacy for their opioid and controlled substance prescriptions. We may also lock members into receiving prescriptions from a single provider. Both measures will help ensure oversight of their total opioid use. Premera will only take these steps once a full investigation with Express Scripts confirms abuse and fraudulent behavior.
Some health plans will have the option to select additional control measures, including:
- Alerting providers when their patient is prescribed a large cumulative opioid dose, or other triggers. Alerts will come via electronic medical records, fax, or letter.
- Member education for new opioid users
- Proactive member outreach by specialized Neuroscience Pharmacists as well as easy to use disposal bags that destroy medicines making them unusable and safely disposable