Oct. 17, 2019
At Blue Cross and Blue Shield of Texas (BCBSTX), we pledge “to do everything in our power to stand with our members in sickness and health.” We take that very seriously and that is why we have started a new program to help you care for members who may be at risk for an opioid-related adverse event. We hope that by collaborating with you and our members, we can find ways to help reduce risk and promote patient safety.
As part of our new program we are now scanning pharmacy and medical claims to identify members with a combination of the following risk factors:
- High morphine equivalent daily dosing (MED)1
- Dangerous drug combinations (i.e., opioids, benzodiazepines, muscle relaxers)
- Receiving controlled substance prescriptions from multiple providers.
When warranted, we reach out to these members and their providers to inform them of potential risks. We also provide support to help reduce that risk. Support may include ensuring members have access to Narcan (naloxone) and are aware of how to use it. We can also suggest non-opioid alternatives such as physical therapy and cognitive behavioral therapy. This initiative is one of the enhancements we made this summer to our behavioral health offerings2.
“The number of opioid overdoses still occurring in this country requires a coordinated effort across the entire delivery system,” said Ben Kurian, M.D., our Executive Medical Director Risk Identification and Outreach Program. “We hope to use our data to partner with providers for the benefit of patients and their families.”
It is our hope that by identifying and sharing prescribing concerns, we can collaborate to increase patient safety and improve clinical care and outcomes.
At BCBSTX, we are always working to improve health outcomes for all our members. Thank you for all you do to ensure the safety and well-being of your patients/our members.
1Source: Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49. DOI
2The Behavioral Health program is available only to those members whose health plans include behavioral health benefits through Blue Cross and Blue Shield of Texas (BCBSTX). Some members may not have outpatient behavioral health care management through BCBSTX. Members can check their benefit booklet, ask their group administrator or call Customer Service to verify that they have these services.
This is only a brief description of some member plan benefits. Not all benefits are offered by all plans. For more complete details, including benefits, limitations and exclusions, please refer patients to their certificate of coverage.