Aetna Cuts Prescription Waste And Abuse By 15%

March 15, 2013

By Cyril Tuohy

InsuranceNewsNet

Aetna programs designed to reduce the use, abuse and waste of prescription drugs slashed usage among its 4.3 million members by 15 percent over a two-year period ending in January 2012.  

“We’re encouraged by the evidence that our misuse, waste and abuse programs are controlling access to drugs with high potential for abuse,” said Yrena Friedmann, director, Aetna Pharmacy Management, in a statement. “We’ll continue to do our part to fight prescription drug abuse. We must remain vigilant for the health and safety of our members.”

The results of the study were released at the Pharmacy Benefit Management Institute’s Drug Benefit Conference in Las Vegas last month.

Prescription drug abuse is an epidemic, with about 2.4 million Americans struggling with addiction to prescription painkillers. Opioid addiction is a leading cause of death in the U.S. and adds $72.5 billion in expense to the health care system each year, according to the Centers for Disease Control and Prevention.

Aetna’s prescription drug abuse prevention programs work in four phases.

The first steps are to control access to the prescription drugs at the pharmacy level by limiting how much of the drug is covered by insurance, verifying medical need before coverage of a drug is approved, and advising the pharmacist if the dosage amount appears unsafe, the company said.

The second step reviews each member’s prescription drug history before a new prescription is filled in order to detect usage patterns.

Plan members suspected of abusing a prescription drug are referred to a pain specialist, encouraged to enroll in a pain management program, and referred to company-approved behavioral health specialists and case management experts, the company also said.

For members who don’t respond to support when it’s offered, Aetna could limit access to prescription drug benefits by restricting access to only one health care provider, curtailing refills, and referring plan members suspected of abusing drugs to state and federal agencies, the company said.

Aetna, headquartered in Hartford, Conn., serves more than 37 million people.

Cyril Tuohy is a writer living in Pennsylvania. He has covered the financial services industry for more than 15 years. He has also written about food, restaurants and travel. He can be reached at [email protected]

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