Any dentists or oral surgeons who’d always hoped to be referred to as “super” and recently received letters from Aetna may be wishing they’d been more specific. The Connecticut-based insurer identified nearly 500 dentists and half that number of oral surgeons that prescribed more than a week’s worth of opioids four times or more over 24 months and sent those “superprescribers” letters informing them that they rank among the top 1% of their industry peers when it comes to opioid prescriptions.
Dr. Harold Paz is Aetna’s chief medical officer, and one of the three doctors who signed the letter. “That’s very powerful,” he told Modern Healthcare. “When you get a letter like that, it causes you to stop and think.”
Paz said that many doctors in receipt of the letter had not been aware that their prescription patterns were any different from any other dentist’s. But a fresh awareness might not be enough to curtail potentially excessive prescribing, at least from the point of view of Dr. Andrew Kolody, co-director of opioid policy research at Brandeis University. “There’s evidence that telling people where they stand compared to their peers doesn’t do very much,” he told Modern Healthcare. However, he applauds Aetna’s latest letter campaign nonetheless.
Aetna has had some success in identifying and notifying superprescribers
Last summer Aetna sent warnings to around 1,000 internists and family physicians who fell into the category of “superprescriber,” refilling prescriptions for opioids around four-and-a-half times, on average. And it’s likely those efforts bore fruit: Aetna reports a 7% reduction in monthly opioid prescriptions among its nearly 10 million commercial pharmacy membership, as well as a 5% drop in monthly prescriptions in the insurer’s Medicare Advantage program (which includes 1 million members).
The Centers for Disease Control and Prevention (CDC) reports that opioids were involved in over 33,000 fatalities in 2015, a 15% increase from the year prior (28,600 deaths). And specifically, prescription opioids were involved in half of those fatal overdoses.
A 2011 study by The Journal of the American Medical Association reported that the highest prescribers of opioids to patients aged 10 to 19 are dentists. And a study published in that same year in The Journal of the American Dental Association revealed that around 12% of all opioids in the country are dispensed by dentists, a prescribing rate second only to family doctors. Aetna says that dentists write roughly 18% of all opioid prescriptions for its members.
Some insurers nix prior authorizations for medication-assisted treatment
Aetna is not alone in joining the bigger fight to combat the nation’s opioid epidemic; a small group of insurers are looking at ways to curtail opioid prescriptions by their providers. Along with Aetna, UnitedHealth Group, Anthem, and Cigna did away with prior authorization requirements for medication-assisted treatment to opioid use disorder; pre-authorizations in those cases have been criticized for postponing treatment at a point in time when the need for it is crucial.
The correspondence from Aetna to the superprescribers also included prescribing guidelines. The CDC suggests that dentists should limit their opioid prescriptions to cases of acute pain, at the lowest dose expected to be effective, and for a three days’ supply at most.
Dr. Paz conceded that there are times when a prescription opioid is the appropriate form of treatment, as in the case of major injuries or cancer (which is why Aetna did not factor those cases into its determination of which doctors were potentially over-prescribing opioids). He said, “We have to ask the question about a young boy who has a root canal and receives a significant prescription of Vicodin. Does that make any sense at all?”
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