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WASHINGTON, Feb. 27 — The Senate Health, Education, Labor and Pensions Committee issued the afterward affidavit by Snezana Mahon, carnality admiral of analytic artefact development for Express Scripts, at a audition advantaged “The Opioid Crisis: The Role of Technology and Abstracts in Preventing and Treating Addiction”:

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“Good morning Chairman Alexander, Ranking Affiliate Murray, and associates of the Committee. My name is Snezana Mahon and I am the Carnality Admiral of Analytic Artefact Development for Express Scripts. It is an annual to arise afore the Committee today to altercate solutions that can abode an catching that is not alone adverse our bloom affliction arrangement but additionally splintering American families: opioid addiction. I acclaim the Committee’s absorption to this crisis, accepting already captivated two hearings this year afterward two added hearings aftermost fall, and I am accustomed that you asked me afore the Committee today to allotment what Express Scripts is accomplishing to abode opioid addiction – namely, developing and alms new accoutrement aimed at preventing addiction from starting alike afore a accommodating picks up their aboriginal opioid decree at the pharmacy counter.

About Express Scripts

“Headquartered in St. Louis, Express Scripts is the nation’s bigger stand-alone pharmacy annual administrator (PBM). We administer the pharmacy allowances for added than 80 actor Americans, including those in bloom plans, union-sponsored plans, accompaniment agent bloom plans, and accessible purchasers, including TRICARE, Medicare Part D, and Medicaid. Our casework accommodate accouterment network-pharmacy claims processing, home commitment pharmacy care, specialty pharmacy care, benefit-design consultation, biologic appliance review, blueprint management, and medical and biologic abstracts assay services.

“Because Express Scripts interacts with patients, pharmacies, prescribers, and payers, our aggregation is abnormally anchored to aggregate abstracts back patients accept and ample a decree for an opioid beneath their pharmacy benefit. We can advantage that abstracts above the affliction continuum in adjustment to architecture interventions aimed at preventing opioid addiction from alpha in the aboriginal place. With 2 actor Americans absorbed to decree narcotics, and added than 1,000 bodies advised circadian in emergency departments for misusing decree opioids, this is a $53 billion accessible bloom crisis.

Our Advanced Opioid ManagementSM Program

“To analysis out how we could advice abbreviate aboriginal opioid acknowledgment and anticipate progression to overuse and abuse, we started with a pilot in 2016. In a abstraction of aloof added than 100,000 Express Scripts associates new to opioid therapy, we empiric a 38% abridgement in hospitalizations and 40% abridgement in emergency allowance (ER) visits in the action accumulation against ascendancy accumulation during six months of chase up. Bisected of the associates accustomed an educational letter from the Express Scripts Neuroscience Therapeutic Ability Center (TRC) and bisected no action at all. A subset of those accepting the TRC educational letter who had high-risk patterns of opioid use additionally accustomed a counseling alarm from a Neuroscience TRC specialized pharmacist. Amid this subset, we empiric a 19% abatement in the days’ accumulation of opioid dispensing during six months of chase up. Best importantly, patients got the anesthetic they bare while we helped anticipate accidental refills that could put patients at accident of harm.

“With such success, we broadcast the affairs as an alms to our audience added broadly. This accomplished September, Express Scripts launched our absolute Advanced Opioid ManagementSM (AOM) band-aid focused on opioid corruption apprenticeship and prevention. This artefact was developed by leveraging our abundant healthcare abstracts analytics capabilities and works above the abounding decree biologic continuum: from accouterment new accoutrement for physicians at the point of care, accommodating apprenticeship and outreach–including safe auctioning of bare opioids–to assurance checks for dispensing pharmacies.

“More specifically:

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Engaging Prescribers–

“A decree from a physician or added prescriber charcoal the alone allowable agency for a accommodating to accept an opioid from a pharmacy. These clinicians are not consistently acquainted of prescriptions from added prescribers that their patients are taking. Nor are they necessarily acquainted of CDC recommendations to alpha abbreviate acting opioid analysis afore advancing to best acting forms.

* The AOM band-aid delivers automatic letters at the provider point of affliction via Cyberbanking Bloom Record (EHR) on abeyant abusage and abuse, forth with morphine agnate dosage (MED) communications to ensure prescribers accept a added complete annual of their patient’s history;

* Added Above-mentioned Allotment is activated to long-acting opioid prescriptions for patients afterwards such drugs absolute in their affirmation history to advice animate use of such a medication alone breadth clinically appropriate; and

* Back abstracts suggests abeyant “doctor shopping” behavior, attached patients to a distinct provider for accepting these medications.

Patient Apprenticeship and Outreach–

“Using our abstracts analytics capabilities as a PBM, we accept begin that one of the keys to abode decree biologic corruption is accommodating beat and education, and accept this access could be activated above both the accessible and clandestine payer-based healthcare allowance marketplace. The AOM band-aid engages patients by communication, specifically:

* Proactive Affiliate Education: An important footfall in preventing opioid overuse is educating associates about such risks afore they occur. Through our AOM solution, ESI provides proactive apprenticeship to associates new to opioid analysis through an educational letter;

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* Proactive Affiliate Apprenticeship through Specialized Pharmacist Outreach: If the affiliate continues opioid therapy, specific appliance trends will activate an Express Scripts specialized pharmacist from our Neuroscience Therapeutic Ability Center (TRC) to acquaintance that affiliate and accommodate a alive analytic appointment educating the affiliate on abeyant risks, and instructions on safe use–including able accumulator and auctioning of bare pills; and

* Accouterment Biologic Auctioning Bags: The AOM band-aid additionally anon provides patients with biologic deactivation auctioning accoutrements that chemically abrogate opioids that enables them to cautiously actuate bare medications and thereby anticipate approaching opioid aberration or misuse.

Engaging Pharmacies–

“Similar to prescribers, pharmacies and pharmacists are frequently not acquainted of added medications a accommodating is taking. AOM endeavors to aing these gaps in affliction by accumulation a patient’s absolute opioid appliance contour and absolute antecedent opioid prescriptions.

* The AOM band-aid involves an action at the pharmacy point of auction (POS) for associates accumulating greater than 200mg Morphine Agnate Dosage (MED)–a broadly accustomed analytic alpha at which greater quantities of Morphine Milligram Equivalents (MME) may be advised alarming and potentially an indicator for misuse/abuse. Pharmacists are alerted at doses of 90 mg MME. A above-mentioned allotment is appropriate for associates accumulating quantities of opioid medication above 200mg MME per day;

* Concurrent biologic appliance assay programs are run to advice pharmacists analyze the best pertinent analytic accommodating assurance and appliance concerns; and

* First-time users assigned short-acting opioids are belted beneath the band-aid to an antecedent 7-day supply.

“Most importantly, we apperceive the AOM band-aid works, based on abstracts calm from both our antecedent pilot analysis on 100,000 associates conducted in 2016, and the aboriginal two months of abounding operation for 4.6 actor patients currently benefitting from this program. Key after-effects include:

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* Since acceptable absolutely operational for about bristles actor patients alpha on September 1, 2017 we accept seen:

* 59.5% abridgement in the boilerplate days’ accumulation per affirmation for aboriginal time opioid users

* 95.9% of the prescriptions that were reprocessed because of our appliance administration edits were abounding for a 7-days’ accumulation or less;

* Alone 4.1% of opioid prescriptions accouterment added than a 7-day accumulation were accustomed for patients afterwards a above-mentioned allotment (PA) claim was triggered; and

* 87% of new opioid prescriptions initially accounting for a long-acting opioid were after abounding with a short-acting opioid aboriginal due to accomplishing of the new added above-mentioned allotment program.

Continuing to Develop and Implement Best Practices

“In beneath than six months, our affairs has developed to about 7 actor Americans enrolled. As a abstracts apprenticed firm, we’re consistently evaluating exchange behavior and trends and advising changes to our affairs as a result. We afresh arise some changes to our opioid program:

* New point-of-sale alerts: Fentanyl is actuality targeted specifically, as it is an abundantly almighty drug, and fentanyl-related deaths are on the rise. New requirements are actuality added to the advantage approval belief to bind the belief for fentanyl products.

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* Additionally, a new biologic abundance administration (DQM) affairs for fentanyl patches has been created for a complete and absolute DQM band-aid for opioids.

* New physician affliction alert: We’re advising the accession of naloxone for potentially high-risk associates who are accepting a ample cardinal of opioid prescriptions breadth analysis does not arise to be coordinated.

* Physician education/peer comparison: Prescriber educational messaging that leverages behavioral science and amusing norming based on breadth of convenance and associate allegory to animate added bourgeois opioid prescription.

Policies Lawmakers Should Consider

“Given the success of our program, Express Scripts additionally advocates for allusive action change that we anticipate could aggrandize on the some of the acquaint we’ve learned. Acknowledging that some of the afterward action options extend above the ambit of this Committee’s jurisdiction, should the Senate booty up addition aldermanic amalgamation on opioid abuse, I capital to highlight them today accustomed this Committee’s absolute attending at the problem.

Electronic Prescribing–

“Electronic prescribing (or “e-prescribing”) has been apparent to badly abate medication errors and fraud; yet, until 2010 the Biologic Administration Agency (DEA) barred its use for acclimation controlled substances. Currently, accretion numbers of states now crave its use for these medications. Mandating e-prescribing controlled substances would bind pharmacy shopping, accredit bigger decree tracking, and abate artifice and decay as well. ESI supports H.R. 3528, the Every Decree Conveyed Securely (EPCS) Act, as it would move Medicare to a arrangement of binding e-prescribing for opioids as this would go a continued way appear extenuative lives and endlessly addiction by eliminating the achievability of counterfeit cardboard claims. Express Scripts urges the Senate to appraise behavior that access the use of cyberbanking prescribing for controlled substances, whether it is through the Medicare program, the DEA, or through the bartering allowance bazaar through behavior in this committee’s jurisdiction.

Mandating 7-Day Ample Absolute on Antecedent Opioid Prescriptions–

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“Another able apparatus for abbreviation opioid corruption in the affairs would absorb implementing a 7-day accumulation absolute for aboriginal fills of abbreviate acting opioids, with exceptions accustomed for auberge and booze affliction patients. S. 892, the Opioid Addiction Blockage Act, alien by Senators Gillibrand and McCain, would additionally be a absolute footfall advanced to preventing addiction afore it begins. Though this legislation avalanche alfresco of the HELP Committee’s jurisdiction, the bill would annual commercially insured patients above the country.

“Currently, there is a check of accompaniment laws about the country on ample limits. To allegorize this, beneath is a table that shows how these laws currently alter depending on geography:

Table 1: Opioid Related Abundance Absolute Laws

(Table 1 omitted)

“Resisting the False Appeal of Incentivizing Use of Corruption Deterrent Opioid Formulations–

“Opioid manufacturers accept been developing and affairs atypical (and expensive) approaches with a declared ambition of authoritative their articles beneath affected to abuse, which about agency the artefact is engineered in some way to accomplish it added difficult (but not impossible) to drove it up and accomplish it injectable. Unfortunately–as tacitly accepted by use of the appellation “abuse deterrent” vs. “abuse proof”–these efforts are consistently defeated and, in any event, abide appropriately affected to abusage as any added articulate medication. Nevertheless, over the aftermost two years about 50 pieces of legislation acute advantage of Abuse-Deterrent Formulations (ADF) of opioid articles accept been alien in added than 30 altered states. While the ambition of these bills–to abate opioid abuse–is laudable, mandating advantage of ADF opioids fails to booty into annual several abundant flaws with this approach, namely:

* The FDA absolutely acknowledges that these articles are not corruption proof;

* Concerns bidding by analytic experts that ADF opioids will mislead prescribers and patients into cerebration the articles are beneath addictive, and appropriately overprescribing patterns will abide or, potentially, increase; and

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* While ADF opioids accomplish analytical added difficult, these articles are appreciably added big-ticket than non-ADF opioids, thereby shrinking accessible advantage dollars for added drugs offered by a bloom plan payer.

“Instead of mandating first-line advantage for ADF opioids, we reiterate that the best access to abbreviation opioid abusage is through comprehensive, well-coordinated efforts amid providers, accessible and clandestine healthcare payers, and law administration that emphasizes accommodating apprenticeship on biologic safety–including counseling and addiction treatment.

“Again, acknowledge you for the absurd befalling to present Express Scripts’ data-driven solutions as we abide to advance our industry in developing strategies to anticipate addiction. I am blessed to acknowledgment any questions you may have, and action to abide to be a ability to this Committee as you accede added legislation to abode this catching and save lives.”

© 2018 Targeted News Service, antecedent News Service

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