Janelle V. Sheen, Pharm.D.

“Opioid addiction is not a new problem, but the epidemic is growing.” – Janelle V. Sheen, Pharm.D., Pharmacy Solutions director for Clinical Pharmacy Services in Xerox Government Healthcare Solutions

Janelle V. Sheen, Pharm.D.

As a pharmacist, I learned about medicines because I wanted to help people. I learned about medications to prevent diabetes complications, medications to lower the risk of heart attack and medications to prevent pain and suffering.

What I have seen since is that medications can just as easily hurt people when not taken correctly or prescribed safely.

In fact, according to the Centers for Disease Control and Prevention (CDC), deaths due to prescription opioid pain medication overdose in the United States more than quadrupled from 1999 to 2014. More than 165,000 people in our country died from overdose relating to treatment of pain with opioid medications. These are lives lost because the medications prescribed to help did just the opposite.

Opioid addiction is not a new problem, but the epidemic is growing. As healthcare professionals battle opioid abuse, we struggle with how to control it. That’s why the healthcare industry is searching for effective ways to better manage opioid safety.

It’s Different for Managed Care

For managed care pharmacists, the plight of opioid abuse is markedly different from traditional pharmacy settings. They don’t have to determine whether to fill 90 oxycodone tablets for a 20-year-old who has filled three other opioid medications in the same week – all from different prescribers. They don’t have to rush extra vials of naloxone, an opioid overdose reversal agent, to the emergency department.

Managed care pharmacists don’t directly interact with patients at all.

In this environment, tackling opioid abuse means examining data from pharmacy and medical claims. It’s especially useful when you work with large populations. This data provides insight into opioid management opportunities that are often overlooked or not able to be tracked otherwise.

Claims data can be used in many ways to assist in the battle against this type of substance abuse. At Xerox, our solutions help state-funded pharmacy programs monitor recipients for safe opioid use – our prospective and retrospective review of opioid prescriptions, for example. We maintain secure databases of up to two years of prescription and medical claims history. Pharmacists like me identify clinical criteria and apply them against the claims data to uncover recipients whose claims suggest inappropriate opioid use. Working with more than 15 U.S. states, we have been successful in reducing opioid overutilization, improving coordination of care and lowering the risk of adverse events.

Data that Saves Lives and Saves Money

One retrospective intervention identified recipients with non-cancer pain who filled claims for high medication doses from multiple prescribers and/or were also at risk for adverse events due to liver and/or kidney disease. We then sent an educational mailer to 457 prescribers about safe opioid practices. Six months later, we saw a 44 percent reduction in both opioid adverse events and opioid dosing-related incidents. A similar intervention reduced clinical indicators for overutilization of drugs with abuse potential by 74 percent and decreased adverse drug events by 71 percent.

Another way we promote safe opioid use is by ensuring opioid claims meet approved guidelines for safety and effectiveness when they are dispensed. Our automated prior authorization solution, Xerox® SmartPA Pharmacy Application, applies clinical criteria when retail pharmacists process opioid claims through their computer systems. The criteria are checked in a matter of seconds against the pharmacy and medical claims history.

For another example, a state client required an appropriate diagnosis, quantity limits and a trial of a preferred opioid medication before approving the current opioid. Implementing these criteria helped the state enforce safe use of opioids, prevent opioid overutilization, and preserve $157,726 for use in improving care in other areas.

Many people think in terms of finding a “magic bullet” in the fight against opioid abuse. But there isn’t one. What we do have are opportunities to use claims data to identify abusive patterns among prescribers, recipients and pharmacies. From there, it takes a combination of several approaches from differing angles – a targeted strategy – to attack opioid abuse and increase opioid safety.

Nationwide, many states have used prescription drug monitoring programs to document and track opioid use. These efforts, along with more emphasis on education about opioid abuse prevention and treatment, are important in slowing the trend of overdose deaths in our country.

With stronger guidance from the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Food and Drug Administration, we can continue to promote safe use of opioids.