Pharmacy benefit manager’s enhanced program helps payers safely address members' pain and lower risk of abuse.
Program helps educate and guide patients prescribed opioids to safely use these powerful drugs.
PRESS RELEASE: In response to the nation’s opioid epidemic, pharmacy benefit manager, EnvisionRx, a division of EnvisionRxOptions, announced enhancements to its comprehensive opioid and pain management program, EnvisionCare Pain Management. Available immediately, the program includes pre-emptive prescription strategies, such as limiting first-time fills to seven days*, prior authorizations on certain medications, and shortened windows to refill prescriptions. This comprehensive program aligns with the healthcare company’s overall pain management strategy, as well as the guidelines set by the Centers for Disease Control and Prevention (CDC).
“As our nation endures a health crisis around opioid dependency, we are in a unique position to change the way opioids are used by our members,” explained Frank Sheehy, chief executive officer of EnvisionRxOptions. “Prescription fill limits and monitoring as a part of our pain management program will help minimize the risk of opioid addiction, especially for those patients who are being prescribed opioids for the first time.”
EnvisionCare Pain Management, which includes an opt-out feature for clients not wishing to implement this program, focuses on patient safety through communication, education and outreach, as well as interventions that avoid excessive dosing and dangerous drug combinations, ensuring pain is managed safely before and after the first dose.
The program contains pre-dispense, concurrent and retrospective measures, such as:
- Clinically focused safeguards, like a seven-day limit on prescriptions for patients who have not used an opioid in the past three months, step therapy for extended-release opioids and prior authorization for extremely high dosages (greater than 200 Morphine Milligram Equivalents (MME)).
- Safer dispensing practices, including real-time drug utilization reviews at the pharmacy to promote proper dispensing and point-of-sale alerts for excessively high dosages or those who have been prescribed dangerous drug combinations.
- Supplemental, detailed reviews, in addition to those the pharmacist performs at the time of dispense, to identify patients who may be filling high dosage opioids, and/or receiving prescriptions from multiple prescribers and dispensers. These reviews, paired with a shortened refill window requiring patients to have exhausted 85% of their medication supply before a refill will be dispensed, help identify dangerous long-term utilization and members who may be in need of intervention.
Programs like these that include controls from before the first dose to retrospective reviews have shown impressive results, such as an annual 42% reduction in the number of opioids filled and a cost reduction of nearly 30%. Additionally, these programs help control indirect costs, such as absenteeism, presenteeism, and added medical expenses due to opioid abuse, which studies show account for eight times more direct healthcare costs than those of non-abusers.
“We firmly believe that by reducing the number of opioids in the hands of a new patient right from the start, we can significantly decrease the possibility of dependence and addiction,” stated Sheehy. “While opioid use can have positive results for pain management, we have a responsibility to protect our members by addressing pain in an appropriate way and better educating patients about the risks accompanying opioids."
* Member requested adjustments to this days’ supply limitation are subject to prescriber review and direction through the prior authorization process.
 EnvisionRx internal reports (2018).  Fudin (2015). The economics of opioids: Abuse, REMS and treatment benefits. American Journal of Managed Care, Vol 21, No 9. August 2015.