Access to buprenorphine and naloxone can save lives. It is paramount that health plans ensure that their prescribers and patients have access to these drugs. Health plans should work with their networks to ensure buprenorphine and naloxone are available at all points in the health care system: hospitals, emergency departments, primary care clinics, mental health clinics, and addiction treatment programs. Plans must also work with pharmacies serving their members to ensure they are stocking and furnishing naloxone. In this section we share stories of health plans partnering with pharmacies and coalitions to ensure naloxone is available in their communities. We also include resources on naloxone prescribing and overdose training for providers.
How to Do It
- Remove authorization requirements, copays, and annual limits for buprenorphine and naloxone.
- Work with pharmacy network to support stocking and furnishing naloxone.
- Promote co-prescribing (of naloxone) in your network.
- Promote medication-assisted treatment (MAT) in your network.
Health Plan Stories
Beginning in January 2018, Aetna waived copayments for Narcan for fully insured commercial members in an effort to increase access and remove financial barriers to the lifesaving drug. Narcan is a brand-name version of naloxone. Prior to being waived, the copayment for Narcan ranged from $0 to $150. When Aetna waived the copayment, it also took steps to limit the quantity of opioids that could be prescribed for acute pain and post-surgery, limiting prescribers to a seven-day supply for commercial pharmacy members.
Aetna, Anthem, and Cigna
Aetna, Anthem, and Cigna removed the prior-authorization requirements for Suboxone in late 2016 (Cigna) and early 2017 (Aetna and Anthem). Anthem and Cigna implemented the change after facing an investigation by New York’s attorney general into whether the insurers’ coverage practices impeded patient access to necessary treatment. California’s Medi-Cal program removed the prior authorization requirement for Suboxone in 2015, and quickly saw a significant increase in use.
Central California Alliance for Health
Health Plan of San Joaquin
The SJCOSC was initiated in March 2018. Its aim is to reduce deaths attributed to opioids. With partner enthusiasm and expertise, the coalition has been able to conduct training, community assessments, strategic planning, educational outreach, and group-based academic detailing. An early coalition effort focused on working to prevent overdose deaths by launching a naloxone distribution program. The goal was to distribute naloxone to the friends and family members of people at risk of overdose. To date, the coalition has given away over 900 naloxone kits received through a grant from the California Department of Public Health.
As each of the SJCOSC partners works with urgency and care to test and implement effective solutions, each also is committed to the guiding principle that any measurable, lasting solutions must be woven into an integrated menu of approaches.
Santa Clara Family Health Plan
“This quantity of narcotics exceeds safe prescribing guidelines. Please co-prescribe naloxone injection, one vial, for overdose rescue.”
In 2016, recognizing that prescribers rarely read approval letters (and members never receive them), SCFHP created a new protocol. All requests for doses greater than 90 MME (excluding hospice and palliative care) were automatically denied unless a claim for naloxone was on file for that member. Denials triggered a letter to the prescriber and member stating:
“This quantity of narcotics greatly exceeds safe prescribing guidelines. Per Centers for Disease Control guidelines, opioid dosages greater than 90 MME per day are associated with increased risks. [For members receiving high-risk combinations of medications, the letter also read ‘The prescribed dosage and combination with morphine sulfate, oxycodone/APAP, and clonazepam are in the lethal range.’] Please resubmit with a prescription for naloxone injection, one vial, for overdose rescue.”
Once the naloxone prescription is documented, the authorization request is approved. With this approach, the health plan gives a clear message to the member and prescriber about safety without the labor-intensive practice of reviewing each case.
Partnership HealthPlan of California
University of Pittsburgh Medical Center
University of Pittsburgh Medical Center covers and promotes overdose education and the use of naloxone products to prevent overdoses. The plan has provided substantial financial assistance to first responders to distribute naloxone kits, and in October 2016 provided information about naloxone to thousands of providers in the community.
- Centers for Disease Control and Prevention: Interactive Training Series: Applying CDC’s Guideline for Prescribing Opioids
- Partnership HealthPlan of California: Managing Pain Safely: Naloxone Toolkit (PDF)
- San Francisco Department of Public Health
- Substance Abuse and Mental Health Services Administration: Medications for Opioid Use Disorder: Treatment Improvement Protocol 63 (PDF)
- Addictive Behaviors: “Opioid-Overdose Laws’ Association with Opioid Use and Overdose Mortality“
- American Society of Clinical Oncology: ASCO Policy Statement on Opioid Therapy: Protecting Access to Treatment for Cancer-Related Pain (PDF)
- Annals of Internal Medicine: “Cost-Effectiveness of Distributing Naloxone to Heroin Users for Lay Overdose Reversal“
- Association for Community Affiliated Plans: Strategies to Increase MAT Prescribing
- BMJ: “Opioid Overdose Rates and Implementation of Overdose Education and Nasal Naloxone Distribution in Massachusetts: Interrupted Time Series Analysis“
- National Conference of State Legislatures: Prescription for Pain Management: 10 State Strategies (PDF)
- Substance Abuse: “A Review of Opioid Overdose Prevention and Naloxone Prescribing: Implications for Translating Community Programming into Clinical Practice“
- San Francisco Department of Public Health: Opioid Stewardship and Chronic Pain: A Guide for Primary Care Providers (PDF)