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Radar On Market Access: Blues Plans Promote Alternative Treatments to Combat Opioid Epidemic

Posted by Jane Anderson on Jun 4, 2019


Blues plans are promoting alternatives to opioids — and are seeing some increased uptake of alternatives such as acupuncture — but are hampered by employer policies that either don’t cover or place limits on many of those alternatives. Still, employers are showing interest in providing alternatives to opioids, plans say, and individual Blues plans are taking steps to update their coverage and encourage physicians to prescribe non-opioid chronic pain treatments, AIS Health reported.

Caesar DeLeo, M.D., executive medical director at Highmark Health, tells AIS Health that Highmark promotes Centers for Disease Control and Prevention guidelines for chronic pain management, which stress non-opioid treatments.
However, DeLeo points out that employer policies don’t cover some of the alternative therapies, which is a disincentive for patients facing chronic pain. "It's at odds with the concept of keeping people off opioids," he says. For example, acupuncture is covered under certain evidence-based guidelines, as is Botox for migraines, he says. Physical therapy, occupational therapy and chiropractic care also are covered, albeit with policy-set limits, and injections and non-opioid medications are covered, he says.

Independence Blue Cross covers mainstream therapies, says Ginny Calega, M.D., vice president of medical affairs. She also notes that employer groups have been interested in alternatives to opioids, and Independence has communicated with both members and physicians about these alternatives.

Blue Shield of California has seen an uptick in the use of alternative treatment modalities for chronic pain, including physical therapy and acupuncture, although it's not clear this is instead of opioids or in addition to opioid prescriptions, says Salina Wong, Pharm.D., director of clinical pharmacy programs.

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Topics: Industry Trends, Payer