BCBS of Alabama launching new opioid management strategy
In an effort to combat the growing opioid abuse epidemic in Alabama and as a measure of concern for their customers’ care and safety Blue Cross and Blue Shield of Alabama is launching a new opioid management strategy. In 2015, 5.8 million prescriptions for opioid medications were given to Alabamians, making it the highest prescribing state in the nation for prescription opioid drugs. According to Blue Cross and Blue Shield Association’s Health of America report on the opioid epidemic: 26 percent of Blue Cross and Blue Shield of Alabama’s commercially insured members filled at least one opioid prescription in 2015, compared to 21 percent nationally 6.5 percent of our members were on a long-duration opioid regimen in 2015, compared to 3.8 percent nationally 16.4 per 1,000 members were diagnosed with opioid use disorder in Alabama in 2016, double that of 8.3 nationally 29 percent of our members with opioid use disorder received medication-assisted therapy in 2016, compared to 37 percent nationally In recent years, Alabama has seen many deaths due to prescription drug overdoses. The use of opioid pain relievers lead to 723 drug-related deaths in 2014, and 5,128 deaths from 2006 through 2014. Therefore, Blue Cross and Blue Shield of Alabama feels that it is necessary to implement the following requirements: Extended-release opioids will require a prior authorization for all initial fills of long-acting opioid medications. Members currently receiving these drugs will not be impacted. Immediate-release opioids will not require prior authorization but will have quantity limits. The first prescription fill will be limited to a seven-day initial supply. After an initial seven day supply is filled, additional prescriptions may be obtained without pre-authorization. Members currently receiving these drugs will not be impacted. Naloxone, the antidote for an opioid overdose, will be available to Blue Cross members for a generic copay. These include the forms of prefilled syringes and nasal spray. Evzio, the branded auto-injector, will no longer be covered due to egregious pricing. The conditions will go into effect Feb. 1, 2018.
State regulators slap BCBS of Alabama with $8M penalty
State regulators have hit Blue Cross Blue Shield of Alabama (BCBSAL) with an $8 million penalty for charging rates other than those approved by the Alabama Department of Insurance (ALDOI). According to AL.com, BCBSAL charged different rates in roughly 1,400 small-group employer plans — those with two to 50 employees — and some COBRA plans for former employees from 2005 to 2013. The result? Nearly $107 million undercharges and almost $33 million overcharges. “The goal was to smooth rate adjustments over time and provide small employers more predictability in their business planning,” said a statement issued by Blue Cross Blue Shield of Alabama to AL.com. “We believed these practices were beneficial overall to our small business customers.” BCBSAL has 60 days to pay the penalty, as well as an additional $100,000 to the department for costs related to the investigation. “Within 60 days of the date of this order, Blue Cross shall pay the amount of $8,000,000 to the commissioner of insurance as an assessment for Blue Cross’ oversight in not filing its renewal rating methodology with the department pursuant to [Alabama law],” the order from ALDOI read. “This assessment is a result of Blue Cross’ inability to reasonably conduct variance analysis outside of the study period due to incomplete data.”
