Health Plans and Insurance Companies

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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

Improve Prescribing Practices

  • 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