Health Plans and Insurance Companies
Return to Strengthen the Coalition to Reduce Opioid Crisis
Return to Improve Insurance & Pharmacy Policies & Practices
Return to Partner Roles
Health Plans can have a major influence on many aspects of addressing the opioid crisis. Having them as active partners in the coalition can help many strategies advance more effectively.
Objectives that Can Be Advanced by Health Plans
Each of these Objectives have links to the pages for those objectives, and this page lists key ways that Health Plans can help to advance those Objectives.
Improve Health Plan (Insurance) & Pharmacy Policies & Practices
- Implement formulary dose limits with prompt authorization review to manage exceptions
- Implement quantity limits with new starts (with authorization requirements for ongoing treatment after first fill)
- Remove high-dose formulations from the formulary
- Remove methadone from formulary for pain
- Remove Soma (carisoprodol) from formulary
- Limit concurrent prescriptions for opioids and benzodiazepines
- Implement pharmacy lock program for patients using multiple prescribers
- Remove Oxycontin from the formulary in favor of other pain medications, even though they are more expensive. See example of BlueCross BlueShield of TN removing Oxycontin from formulary
Expand Programs & Options for Chronic Pain Prevention
- Add or expand coverage for chiropractic services for chronic pain prevention
- Add or expend coverage for acupuncture services for chronic pain prevention
- Add or expand coverage for health education or mindfulness as a way to prevent chronic pain
- Train case managers in chronic pain prevention
- Support research on strategies for chronic pain prevention
Increase Access to Alternative Therapies to Treat Pain (Chronic Pain Management)
- Remove prior authorization requirement for the first course of physical therapy for back pain
- Add or expand coverage for chiropractic services to treat pain
- Add or expend coverage for acupuncture services to treat pain
- Add or expand coverage for health education or mindfulness as a way to prevent chronic pain
- Train case managers on chronic pain management
- Add or expand coverage for new pain management modalities such as VR or electrical stimulation
- Support research on new modalities for treating chronic pain
- Ensure access to in-network pain specialists providing alternative therapies
Increase Tapering off Opioid Pain Medication
- Support programs to help providers develop tapering plans
- Track and analyze data on tapering to improve approaches to tapering
- Add coverage to DNA testing to support tapering
Expand Access to Less Addictive Pain Medications
- Remove prior authorization requirements for common non-opioid pain mediations (e.g. anti-depressants, neuroleptics with indications for pain)
Improve Professional Training on Opioid Risks & Alternative Pain Management Approaches
- Offer or support provider education on pain management based on prescribing guidelines (CDC or medical board)
- Ensure access to in-network pain specialists aligned with DCD guidelines for peer consultation or secondary case review
- Work with inpatient and outpatient provider network to change preset opioid prescribing order sets
Use DNA Testing & Precision Pain Medication Practices
Expand & Enhance Use of Prescription Drug Monitoring Program
Increase Awareness of the Crisis and Risks
- Provide member education on opioid risks and non-opioid pain management strategies
Improve Detection and Treatment of Mental Health Conditions
Become a Trauma-Informed Community
Improve, Align & Integrate Relevant Collective Impact Efforts
Improve Alignment Among Funders Working to Address the Opioid Crisis or Related Issues
Improve Collaboration Among Government & Healthcare Organizations
Enhance & Expand Data Sharing Among Relevant Systems
Expand the Development & Use of Centrally Managed Personal Care Pathways
Enhance the Processes and Capacity to Taking a Holistic Approach to Care Coordination
Expand SBIRT Programs
Improve & Expand Screening & Testing or Misuse
Improve Access to Quality Treatment Programs
Improve Information on Treatment Program Quality & Results
Expand Long-Term Treatment Options when Required
Strengthen Peer Recovery Support Services and Programs
Improve Affordable & Supportive Housing Options for People in Recovery
Improve Allocation of Funding to Improve Community Impact
Improve Enforcement of Parity for Mental & Behavioral Health Treatment
Improve Screening for Infectious Disease among Opioid Users
Expand Law Enforcement Assisted Diversion Programs
Expand Programs Similar to the Angel Program
Expand & Enhance Drug Courts
Enhance Treatment During Incarceration
Expand the use of MAT in Correction Facilities
Support Recovery During Parole
Improve Reentry after Incarceration for People with SUDs
Increase Opportunities for People to be Prescribed Buprenorphine
- Offer or support provider training on buprenorphine prescribing (e.g. waiver training)
- Contract with Medication-Assisted Treatment telehealth providers
- Work with local opioid safety coalitions to build new MAT access points
Expand DNA Testing to Improve Precision MAT Therapies
Improve Public Understanding of the Value of MAT
Increase and Optimally Allocate More Funding for MAT
Offer financial incentives or alternate payment models to encourage primary care providers to treat addiction with buprenorphine
Improve Awareness of MAT Prescribers and Payment Options
Eliminate Insurance Company Prior Authorizations for MAT
Minimize the Influence of Investor Profit Maximization in Treatment Programs
Improve the Access to Naltrexone Related Treatment Approaches
Improve the Use of Methadone Maintenance
Accelerate the Development of New MAT Approaches
Reduce Opioid Prescriptions for Women of Reproductive Age
Taper Off Opioids or MAT for Women of Reproductive Age
Enhance Efforts to get Women of Reproductive Age with OUDs to Treatment
Improve Mental Health Services for Women of Reproductive Age
Increase Access to Contraception
Increase Access to Family Planning & Preconception Care for Women who Use Opioids
Expand Preconception Motivational Interviewing
Expand Access to MAT for Pregnant Women
Adopt Universal Screening for Pregnant Women
Expand SBIRT in Maternity Care Clinics
Reduce Stigma for Pregnant Women with Opioid Addictions
Shift from Punishment to Health focus for Pregnant Women Misusing Opioids
Expand Motivational Interviewing for Pregnant Women
Improve Safe Medication Options for Pregnant Women
Expand Perinatal Treatment for Women with SUDs
Improve Access to Recovery Coaches for Mothers of Babies with NAS
Improve Care for Babies Born Drug Dependent
Enhance Collaboration among Medical, Behavioral, & Social Services for Mothers with SUDs
