Blue Cross Blue Shield issued a report on the opioid crisis with their data from all members in their commercial plans.
Early in the document, they report a pair of striking numbers.
First, that 21% of members filled a prescription for an opioid in 2015. I’ve heard these kinds of numbers before, but I never get numb. That’s 1 in 5 members, despite growing attention to excessive prescribing of opioids.
Second, a 493% increase in diagnosis of opioid use disorders over 7 years. My reaction is that this has to reflect changes in coding or diagnostic practices rather than the population. It’s implausible that there was an increase this large in the number of people with an opioid use disorder.
The document then devotes a great deal of attention to opioid prescribing.
Toward the end, there are a couple of graphics that caught my attention.
First, a map showing rates of opioid use disorders.
Though critical to treating opioid use disorder, the use of medication-assisted treatments (e.g., methadone) does not always track with rates of opioid use disorder (compare Exhibits 10 and 11). For example, New England leads the nation in use of medication-assisted treatments but it has lower levels of opioid use disorder than other parts of the country
So . . . they note that New England has average rates of opioid use disorders, yet they have high rates of utilization of medication-assisted treatment.
This caught my attention because New England has higher rates of overdose, as depicted in the CDC graphics below.
(It’s worth noting that BCBS is not among the top 3 insurers in Maine or New Hampshire, but they are the biggest in Massachusetts and Vermont.)
It begs questions about what the story is, doesn’t it?
I don’t presume to know the answers.
- What was the sequence of events for the high OD rates and the utilization of MAT? And, what impact, if any, has the expansion of MAT had on overdose rates?
- Is the BCBS data representative? (This brand new SAMHSA report suggest that the data about use is representative.)
- We know that opioid maintenance meds reduce risk of OD, but we also know that people stop taking these meds at high rates. Does this imply that, in the real world, these meds end up providing less OD protection than hoped?
- What are the policies and practices of the other insurers in the state? (For example, we know that Anthem [the largest insurer in Maine and Vermont] recently ended prior authorization requirements for MAT. It’s not clear how restrictive they had been. They also are attempting to institute reforms to address the fact that, “only about 16 to 19 percent of the members taking the medications for opioid use disorder also were getting the recommended in-person counseling.”)
- Are there regional differences in drug potency that explain this?
Let’s hope that more insurers follow suit and share their data.