Praise and concerns over new Anthem opiate monitoring program

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INDIANAPOLIS, Ind. (JULY 7, 2016) -- Anthem’s new “Home Pharmacy Program” is aimed at cutting opioid addictions.

The Indiana-based insurance company is now keeping a closer eye on customers’ prescriptions, something doctors often fail to do. With packed schedules, many don’t check Indiana’s statewide database for their patient’s prescription history.

Anthem’s system will track the number of doctors prescribing a customer narcotics, how many scripts customers fill and pharmacies they go to in order to fill them.

If the number is extraordinarily high over a 90-day period, customers will get a warning from the company.

“If you’re not addicted, but you’re using five different doctors or five different pharmacies, you’ve got a problem,” says former prescription narcotics abuser Scott Mitchell.

They’ll have 60 days to change their behavior or their medical providers will be notified and they’ll be limited to using just one pharmacy.

Mitchell has a billboard on I-65 near Lebanon advertising his services supporting heroin addicts attempting recovery. He says he and many of the people he helps started with prescription opiates before moving to heroin once they became harder to get their hands on and use.

“I was a prescription pill taker and I abused my pills,” says Mitchell. “Once they made it harder, they changed the pills up, made it to where you couldn’t snort them, shortly after that, the supplies dropped and heroin was coming around because it was easier to get, it’s cheaper and you get a better high.”

He hopes that alongside prescribing practice changes initiated by doctors, Anthem’s new system could help some opiate addicts get treatment before moving on to heroin.

But he and Eskenazi Health’s Dr. Palmer Mackie both believe some people may be prompted to move to heroin once they’re not able to doctor shop and fill at several different pharmacies under their plan.

“When individuals get cut off, it’s a desperate time,” says Dr. Mackie. “They’re more likely to go out on to the street and get the cheapest thing available, which currently is heroin.”

A spokeswoman from Anthem tells me they already have a similar program in place for Medicaid. While they don’t have data, she says in their experience, the provider notification period isn’t likely to lead its members to switch to heroin.

Dr. Mackie also believes Anthem’s system could be improved by getting rid of the 60-day period between a customer’s warning and notification to medical providers.

“To some degree, I think it’s providing these individuals who are getting these frequent prescriptions, rope to hang themselves with because they’re going back to the same providers to get refills on their prescriptions,” says Dr. Mackie. “The providers don’t know that they’ve been warned and if the providers are not checking the prescription drug monitoring system and not doing urine drug monitoring, and looking at other collateral pieces of information, they’re going continue in that same way.”

Dr. Mackie also disagrees with Anthem’s decision to not include people with a history of HIV, sickle cell anemia, multiple sclerosis or cancer. He says those people are still at risk for addiction to opiates and should not be excluded from the tracking program.

Despite his concerns, Dr. Mackie says he doesn’t disagree with the theory behind Anthem’s new system—that if patients are caught earlier in their addictions or on the path to addiction, they can be helped before disaster strikes.

Mackie says he wants Anthem to work with doctors to use more of their information to improve the program and not potentially create unintended consequences.

“I would love to see them use some of their diagnostic codes, for instance a history of opioid overdose or post-traumatic stress disorder and to use these as indicators to reach out to providers, you know, before all hell breaks loose,” says Dr. Mackie.

It’s both his and Mitchell’s hope that if other insurance companies follow Anthem’s lead, they’ll already know what works and what doesn’t.

“This might not be the 100 percent answer, but I think that we have to do whatever we have to do,” says Mitchell. “We have to think of new things, we have to go outside the box. We just have to do anything and everything we can to keep fighting.”

Anthem’s spokeswoman says they’re always open to making tweaks and changes to the program to make improvements.

If you or someone you know is struggling with addiction, there are dozens of resources across the state.

Scott Mitchell is willing to help any addicts, but specializes in helping those addicted to heroin. He encourages people to call his personal cell phone so he can help point them to the appropriate resources. That number is 765-336-4750.

You can also call information hotline 211, which also has a database of addiction treatment resources.

Other recovery programs include the Salvation Army Harbor Light Center, an inpatient rehab support facility and treatment facilities funded by the state’s Family and Social Services Administration.