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Horizon BCBSNJ’s Efforts to Combat Opioid Addiction

The ongoing opioid addiction epidemic tragically affects lives and families across the country, claiming thousands of victims in New Jersey alone.

Horizon BCBSNJ is combatting the epidemic by:

  • Enforcing the clinical practice guidelines we recommend our in-network doctors and other health care professionals follow to prevent the overprescribing of opioids, and
  • Carefully monitoring the prescription acquisition and filling patterns of members related to opioids.

Analysis of claims data allows Horizon BCBSNJ to track when painkillers such as Percocet®, OxyContin® and Vicodin® (and available generic versions) are prescribed by our in-network doctors and other health care professionals. Claims data analysis also allows us to spot potentially inappropriate activity when members acquire opioids through our in-network doctors, other health care professionals and participating pharmacies.

Our Opioid Safety Programs

Below is a list of programs Horizon BCBSNJ currently has in place to identify and prevent activity that may contribute to opioid abuse.

  • Controlled Substances Alerts – Identifies members on multiple controlled substances with a claims history suggesting misuse or abuse.
  • Triple Therapy Alerts – Identifies members receiving a narcotic, benzodiazepine and muscle relaxant from multiple doctors.
  • Opioids with Multiple Providers Alerts – Identifies multiple duplicate fills of opioids with multiple providers.
  • Pharmacy Lock-in Program – Members at high risk are identified and designated a single pharmacy to fill their prescriptions.
  • Prescriber-focused Risk Identification Program – Prescribers with high-risk prescribing behaviors are identified and receive quarterly reports on actions to reduce risk scores.
  • Five-Day Limit on Acute Opioid Prescriptions – Quarterly identification of and outreach to prescribers who are non-compliant with the five-day limit for initial opioid prescriptions in New Jersey.
  • Utilization Management and Appropriate Use of Opioids
  • Utilization management programs have been enhanced to ensure opioid prescriptions and transition to chronic opioid use is clinically appropriate.
  • Retrospective identification of members who are taking multiple short- or long-acting opioids inappropriately, or taking high doses of opioids with other medications that can increase the risk of overdose.
  • Clinical evaluation of members who have filled an opioid prescription while currently on treatment for opioid use disorder.
  • Predictive Modeling – Using the power of predictive modeling to conduct early identification and review of members at high risk for opioid dependency.

Horizon BCBSNJ is committed to working with our in-network doctors and other health care professionals to help ensure the appropriate prescribing of opioids.

Published on: March 19, 2018, 05:53 a.m. ET
Last updated on: April 26, 2021, 02:13 a.m. ET