Friday, January 24, 2020

Self-Insured Employers Turning to PBMs to Fight Prescription Drug Abuse

More than 10 million people in the United States misused a prescription opioid in 2018, and the opioid epidemic cost the country $179 billion including mortality, health care expenses, lost productivity, criminal justice expenses and assistance. The National Safety Council notes that the annual direct health care costs of individuals who misuse opioids are 8.7 times higher than those who do not.

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The opioid epidemic offers an example of a preventable, complex public health and safety issue that has arisen due to a perfect storm of causative factors. Consequently, it requires multiple stakeholders to develop and deliver an effective solution to help lower costs and improve patient health outcomes. These stakeholders include health care providers, pharmacies, drug manufacturers and even employers.

Tyrone's Commentary:

Benzodiazepines, sometimes called "benzos", are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. Benzodiazepines can be taken in overdoses and can cause dangerous deep unconsciousness. When combined with other central nervous system (CNS) depressants such as alcoholic drinks and opioids, the potential for toxicity and fatal overdose increases. 

Benzodiazepines are commonly misused and taken in combination with other drugs of abuse. According to the National Institute on Drug Abuse statistics, about 30% of what is labeled opioid overdose is actually opioid-benzodiazepine overdose. Benzodiazepines might be a 'hidden element' of the US' overdose epidemic -- and doctor visits for prescriptions are increasing.

Abuse of Xanax, Valium or any other benzodiazepines can quickly lead to addiction and place a person at risk of overdose and deadly withdrawal symptions. Because we have the tools, PBMs must take the lead in preventing the abuse of benzos from becoming another opioid crisis.

However, the pharmacy benefit manager is one player in the opioid crisis that fills a critical role by employing clinical programs to ensure safe and appropriate utilization of medications. The PBM is a third-party administrator of prescription drug programs and primarily responsible for contracting with pharmacies for network services, negotiating discounts and rebates with drug manufacturers, developing and maintaining the plan’s list of covered drugs (a formulary), and processing and paying prescription drug claims.

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