'Less chance of abuse’: Canadian insurers seeing success with opioid intervention programs

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Canadian insurers are seeing signs of success in opioid intervention programs that aim to reduce the amount of medication being dispensed to patients.

After launching a program last spring, Manulife Financial Corp. has intervened on 2,280 prescriptions for opioids that were written for an average 17-days’ supply between the months of April and July. By limiting the number of days that could be claimed at a single time, the program was able to reduce the amount of medication being dispensed by 10 days.

“Fewer leftover drugs means less chance for abuse, misuse and addiction,” said Donna Carbell, head of group benefits for Manulife Canada.

“There are now 22,800 fewer days’ supply of opioids" in circulation, she added.

With the rising number of overdoses and deaths caused by opioids, the federal government declared the opioid crisis a public-health emergency, estimating there have been almost 13,000 apparent opioid-related deaths in Canada since 2016.

“Most people addicted to opioids are first introduced to the drugs through a prescription painkiller and it is often not the person it was prescribed for,” said Ms. Carbell, in an interview. “Employers and insurers have a chance, and an obligation, to help reverse that trend."

Manulife’s opioid management program was introduced for group benefit drug plans in April. As a result, Manulife expects to reduce costs for “unnecessary claims” by approximately $300,000 in the first year. The program encourages doctors to consider the use of short-acting opioids; it also intervenes on patients who are using opioids for the first time, or patients who have not had an opioid prescription in the past six months. The program does not look to disrupt treatment programs for serious cases, such as cancer patients.

During the same four-month period, there were 380 instances in which a doctor prescribed a long-acting opioid before a short-acting version of the drug. But these instances only account for 0.8 per cent of all claims for first-time opioid patients – meaning doctors are looking to prescribe short-term opioids in “almost all instances.”

There has been a hesitancy in the insurance sector to discuss programs that appear to intervene with what a physician can prescribe to patients; but as employers become more aware of the risks associated with addiction, they are responsive to programs that can help minimize the misuse of opioids.

Over the last decade, Sun Life Financial has introduced several processes to manage the misuse of opioids in its group benefits business. One example is putting a cap on the dollar amount each patient can claim for select drugs.

“The goal of all our plans is to provide clients with the prescription medicines needed while also limiting the risk of misuse,” said Gannon Loftus, a spokesperson for Sun Life.

Over the past four years, the total percentage of opioid claims for Sun Life Group clients has decreased, as well as the total spent on this class of drugs. (Sun Life would not release exact figures on how much opioid claims have dropped by.)

Great-West Life Co. confirmed it has measures in place to manage opioid claims but would not comment on them.

The Canadian Life and Health Insurance Association, which represents 99 per cent of Canada’s life and health insurance companies, has participated in several stakeholder round tables on the opioid crisis since 2016. Within its membership, the organization says it has seen several different approaches being used by companies.

Along with setting limits on certain prescriptions, other methods include pharmacist education, encouraging appropriate de-prescribing (where a pharmacist replaces the drug with something less addictive) and advising employers on different benefit plan options that encourage alternate methods to pain treatment, such as physiotherapy and chiropractic care.

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