The House Select Committee on Opioids & Substance Abuse met on April 17 to discuss interim charges related to the impact of substance abuse disorders, co-occurring conditions, vulnerable populations, public and private treatment services, as well as children and foster care. The report below details discussions on these charges.

This report is intended to give you an overview and highlight of the discussions on the various topics the committee took up. This report is not a verbatim transcript of the hearing; it is based upon what was audible or understandable to the observer and the desire to get details out as quickly as possible with few errors or omissions.

 

Opening Comments

  • Chair Four Price – In addition to the 3 posted charges, this hearing will also hear testimony on children and foster care, one witness will present on this topic as they could not attend the future hearing where this issue will be discussed
  • Garnet Coleman – 2/3s of children in foster care are present with substance abuse as a co-occurring disorder, continues to rise

 

Children & Foster Care

Sherry Lachman, Foster America

  • Working in foster care due to personal experience with assistance as a foster child
  • 440k children in foster care, up 40k from 2011
  • Poverty and neglect are the main reason for children to enter the system, but parental drug addiction is growing
  • Foster homes have decreased nationally as foster children numbers have risen, Harris County has large capacity challenges in Texas
  • Children who have been in foster care are 5x more likely to abuse drugs, 1/3 of homeless adults were in foster care, co-indicated in many social issues
  • Federal government is taking action to help, Family First Act is bringing sweeping changes
  • Federal funds are going to be able to be used on family drug treatment, but Texas needs to provide a 50% match to leverage
  • Family drug courts have proven very effective and should be supported, other states are exploring family-based treatment options with great success
  • Foster America is focused on networking with various sectors to solve issues leading children into foster care
  • Texas could similarly bring together a network of professionals to help develop solutions
  • Coleman – You have fellows in how many states?
    • 9 counties and states
  • Coleman – What do you see from these placements around the country?
    • Across the country, we are seeing a huge increase in the number of children and families entering child welfare systems
    • Also seeing a larger appetite from states and counties for remaking the model of child welfare to focus on prevention
  • Coleman – Do other states use family drug courts? Good intervention program?
    • Some are, seeing much better outcomes where they are used
    • But this infrastructure is scattered and spotty which harms effectiveness
  • Coleman – Looking at the data, it seems to be largely a rural phenomenon, Jasper County seems particularly affected
    • See similar things in other states across the US
  • Coleman – Do you see and racial trends regarding who is in foster care?
    • Majority of children in foster care are white, but other ethnicities are hugely over-represented in foster care
    • Interesting to look at other drug epidemics, parallels can be drawn to cocaine epidemic, etc.
    • Previously these problems were not treated as public health issues, this one is and seeing many good attempts
  • Coleman – So we can look back at the cocaine, meth, etc. epidemics and help develop demand reduction solutions
    • Exactly, many family-based treatment solutions were started in previous epidemics, and though they were not effective then, it has built up an evidence base
  • Price – Do you have any examples of good tactics other states have employed? PMP, OTC solutions, etc. have been effective in Texas
    • Common denominator in programs that work is that they are holistic and address the needs of parents and children
    • One example is a program that identifies where a child would be placed well in advance of a crisis
  • Poncho Nevarez – It seems that the root cause is foster care, but can be confusing to identify the best place to start; Solutions that are effective look to be preventative & this will save us money on the back end
    • Correct, right now the effective programs focus not on how much money is spent, but how it is spent
    • Many costly problems later in life can be mitigated with supportive effort during childhood & effort to combat child maltreatment
  • Nevarez – Treating children better makes use more effective and efficient
  • Price – We will have additional testimony on this subject at a later time

 

Posted Charge 1: Study the prevalence and impact of substance use and substance use disorders in Texas, including co-occurring mental illness. Study the prevalence and impact of opioids and synthetic drugs in Texas. Review the history of overdoses and deaths due to overdoses. Also review other health-related impacts due to substance abuse. Identify substances that are contributing to overdoses, related deaths and health impacts, and compare the data to other states. During the review, identify effective and efficient prevention and treatment responses by health care systems, including hospital districts and coordination across state and local governments. Recommend solutions to prevent overdoses and related health impacts and deaths in Texas.

Matt Feehery, Memorial Hermann Prevention and Recovery Center

  • Opioids are easy to get addicted to and leads to hard drug use, costly problem
  • Practitioners recently have been reducing prescription of opioids
  • While opioids are not currently the largest drug problem, they are harmful & efforts to raise awareness are good
  • Number of related deaths continues to rise about 10%/yr in Texas, primarily fueled by heroin and fentanyl overdose
  • Heroin is becoming a convenient alternative and is being driven by increasing restrictions on opioids, but we need to start somewhere
  • Prevalence of fentanyl mixed with drugs is driving overdose numbers
  • Substance abuse disorder are very treatable, but this is a chronic relapse disease and needs continuous effort; Tangential efforts like preventing accidental death, disease transmission, and reducing related crime are important
  • Medication-Assisted Treatment (MAT) is very helpful in managing addictions, seeing more opportunities to use this
  • MAT using addictive substances can be counterproductive in cases where individuals use other substances, antagonists like naltrexone are also an important component
  • Price – The 800 physicians waivered to use opioid treatments like this, are they more heavily located in urban areas?
    • Yes, though now that the rules have been expanded PAs can assist with special training
    • A lot of the counseling and wrap-around services are needed for this however, otherwise these visits are only dispensing visits
  • Need to manage and monitor MAT carefully as the medications do have a street value, so can contribute to the problem; There is a place for it, but challenging
  • In rural Texas this problem is exacerbated
  • New rules by HHSC are requiring this type of treatment, however access is limited and problems persist
  • Memorial Hermann prefers the antagonist approach
  • Hospital programs to reduce opioids pre-op and post-op are seeing success, patients are also becoming more informed and asking for other solutions from physicians
  • Intervention is very important, naloxone is crucial to prevent overdose, screening should be supported and personnel should be educated properly
  • Access to treatment at all levels is important, public and private programs are essential
  • Positive trend is treatment moving from an episodic model to a treatment model
  • Parity insurance is another important initiative, behavioral health coverage should be similarly focused on
  • Need more research into addiction and how to “rewire” the brain
  • Proud of the work done by Memorial Hermann, abstinence-based care program has been effective
  • J.D. Sheffield – Many grew up with the idea that addiction was a moral failing, can you comment on the genetic component?
    • Sometimes it is inherited, the addictive portions of the brain can be activated and some individuals have a more difficult time
    • Usually a good idea not to push it if a person’s family has a history of addiction
  • Sheffield – Coming out of treatment, the brain can still be “scrambled;” Have heard that it can take up to 2 years to reestablish normalcy
    • This is why support services are important, takes a long effort to treat chronic disease
  • Sheffield – Do you have any experience with medical marijuana becoming addictive?
    • Medical marijuana dispensed in an evidence-based way could be beneficial in some situations
    • Smoking anything is not good for your health, however, and potency is scary
  • Sheffield – Last session we passed a bill for a non-THC cannabinoid, asks after the possibility of addiction
    • Probably eliminated
  • Carol Alvarado – Can you comment on what opioids are prescribed in Texas or used most and for what?
    • Follows national trends, oxycodone, hydrocodone, etc.; Vicodin is highly prescribed
    • Very effective at treating pain, but should only be dosed for a few days; Problem came from very long prescriptions
    • Originally focused on cancer and end-of-life pain, physicians were lulled into the belief that these medications were the most effective for most issues
  • Andrew Murr – What do you base the belief that methamphetamine is more of a problem on?
    • Part of it is what I’ve heard in discussions with other professionals, part of this is what is seen in the Memorial Hermann treatment center
  • Murr – Have you analyzed why that is?
    • Methamphetamine has always been a popular drug, easy to produce, access is high, and highly addictive
  • Murr – Do you think because of some opioid void in rural areas, methamphetamine has filled it?
    • Part of it
  • Ina Minjarez – Can you estimate how costly MAT drugs are?
    • Familiar with cost from insurance, generics are available in some sectors, but they are limited

 

Amy Granberry, Charlie’s Place Recovery Center, Association of Substance Abuse Programs

  • Discusses the efforts of Charlie’s Place, ~150 beds with 55 funded by the state
  • 2 years ago, heroin surpassed alcohol as most prevalent, methamphetamine is also rising
  • Have been focusing on training nurses to better handle addiction, maintains a partnership with LMHA who houses a team in the facility to extend services & provide wrap-around services
  • Beginning a program in June to be a drop-off place for the police department
  • 4 LMHAs in the service area of Charlie’s Place, work with all to meet needs of differing areas
  • Indigent care treatment centers see many patients who were previously successful, indicative of disease and treatment can help reintegrate patients into society
  • Also looking into more MAT, can help keep individuals alive until they find recovery treatment
  • Naloxone kits have been provided to all opioid users, providing advanced opioid education before they leave
  • Waiver doctors are largely in the metro areas
  • MAT policy needs to couple treatment into the dispensing, outpatient, inpatient, etc. – whatever the patient needs
  • Murr – For FY2017, heroin was the primary substance Charlie’s Place treated and this was a recent development, what was it before?
    • Was heroine for the prior 2 years, alcohol for 50 years prior to that
  • Murr – Have you looked at the origin of patients and substance abused? Could be useful data to have?
    • We do track this, have not gathered for presentation yet
  • Joe Moody – Aside, there is research on medical marijuana-related to opioid deaths in state with legislation movements, would be useful to look at this to understand the information
    • Looked at this for the Senate as well, found studies on both sides of issue

 

Posted Charge 2: Review the prevalence of substance abuse and substance use disorders in pregnant women, veterans, homeless individuals, and people with co-occurring mental illness. In the review, study the impact of opioids and identify available programs specifically targeted to these populations and the number of people served. Consider whether the programs have the capacity to meet the needs of Texans. In addition, research innovative programs from other states that have reduced substance abuse and substance use disorders, and determine if these programs would meet the needs of Texans. Recommend strategies to increase the capacity to provide effective services.

 

Lisa Ramirez, Health and Human Services Commission

  • Link to presentation
  • Neonatal Abstinence Syndrome (NAS)
    • Has been an increase in diagnoses of NAS
    • Historically, Bexar County has accounted for 1/3 of cases, roughly 3x the state average per capita
    • Nueces County is roughly 2x the state average
    • Texas has a longer length of stay for NAS than national average (~3 weeks), but costs are lower than national average
  • Coleman – Can you explain NAS?
    • Set of symptoms that can occur in newborns due to abrupt cessation of opioid exposure, can occur with maternal use of opioids
    • Can include gastrointestinal issues, poor feeding, sensitivity, etc.
    • Temporary condition with no long-term effects associated, last approximately 2 weeks
  • National strategies to prevent maternal opioid abuse and NAS is primary prevention (safe prescribing, guidelines, messaging, etc.), secondary prevention (treating NAS and maternal abuse, MAT, etc.)
  • First line of treatment for NAS includes involving mother in care, second line is pharmacological
  • State strategies align with national recommended strategies, bolstered education programs and encouraged mothers likely to deliver babies with NAS to appear earlier for treatment/get involved in pre-birth care
  • Price – Does TTOR address any of this?
    • Primary strategies are covered partially by TTOR, but NAS initiative was an outcome from the 84th Session
  • Price – So the TTOR funding doesn’t cover this, the NAS initiatives are separate?
    • To some degree there has been an impact by TTOR, rate increases have affected MAT programs
  • Toni Rose – How are you able to determine that a case NAS would be due to opioids?
    • HHSC has a training symposium every year, in one year it was noted that early infant removal to the NICU could imitate NAS symptoms
    • In other cases, like alcohol, symptoms will not be recognizable until much later in development
    • Recognition of NAS has been improved recently, increased identification could lead to high numbers in areas like Bexar County
  • Rose – Are there distinct symptoms for different substances? Can you determine?
    • A suite of symptoms is different, also consider the account of the mother
  • HHSC also runs opioid overdose education programs, importance of maternal care, and opioid morbidity study
  • Maternal Opioid Morbidity Study
    • Conducted by UTHSC San Antonio, expanding to El Paso, Nueces, Harris, Taylor, and Dallas Counties
    • Study of those who have experienced relapse, goal is to understand themes associated with relapse and overdose
    • Identified need for support due to increased stress of pregnancy
    • Trauma is highly correlated with individuals in this population
    • Study is intended to result in the development of a new screening instrument for relapse
  • Highlights other HHSC efforts
    • Recovery Oriented Systems of Care – Framework for coordinating multiple systems, services, and supports that are person-centered, self-directed; Multiple systems across the state
    • Recovery Support Services – Nonclinical assistance services, incl. community-based organizations, recovery community organizations, and treatment organizations; Patient metrics drastically improved with involvement
    • Senate Bill 55 (84R), 2015, directed HHSC to establish a veteran grant program to support community mental health programs, grants support wide range of clinical mental health and support services
    • Senate Bill 1325, (81R), 2009, established the Mental Health Program for Veterans to provide peer-to-peer counseling for veterans
    • Oxford House program is a peer-run recovery residence program that is democratically run, self-supporting, and substance free

 

Manda Hall, Department of State Health Services

  • Link to presentation
  • Much of the effort on maternal mortality stems from a 2016 article highlighting high levels of mortality and morbidity in mothers, identified ~140 deaths
  • DSHS study on 2012 data was then conducted which used a more accurate method, study showed a much lower rate of maternal deaths within 42-day time period; Matched data to birth or fetal death, or evidence of pregnancy post-mortem, also identified deaths that should have been classified as maternal deaths
  • New number is 56, less than half of original number reported
  • Some issues still remain, black mothers see much worse outcomes generally, also much room for improvement to meet national 2020 goal
  • Rose – What was the cause of death for the other individuals?
    • 74 did not have evidence of pregnancy, 11 did not have evidence of pregnancy within time period of death, others did not have enough data to identify
  • Price – Aside from enhancing analysis, what is being done to improve input data?
    • DSHS is providing training to those inputting data into system
  • Enhanced method will be used in all further analyses to provide accurate data
  • Murr – Why do we use the 42-day time period?
    • Task force reviewing is looking at time period of 365 days to increase knowledge of causes of death
    • 42-day period comes from WHO, typically deaths within this period are heavily related to the pregnancy

 

Lisa Hollier, Maternal Mortality and Morbidity Task Force

  • Opioid abuse is recognized as a chronic disorder
  • Task Force preformed an in-depth analysis of drug-related maternal deaths, looked at 2012-2015 & conducted personal review of records
  • 365 days also captures deaths related to cardiovascular conditions, etc., important for accuracy of data
  • Drug overdose was found to be the leading cause of death during studied period, majority of these deaths occurred after 60 days post-partum
  • 382 confirmed maternal deaths in 365 days, 64 were caused by drug overdose, 49 involved a combination of drugs, 37 involved opioids
  • Risk was highest amongst women 40 and over, those residing in urban counties, those residing in DFW or the Panhandle, white mothers

 

Manda Hall, Department of State Health Services

  • DSHS is working with Aim to develop safety bundles on maternal hemorrhage, hypertension, and substance abuse disorder
  • Texas AIM is consistent with SB 17 (84R)
  • Opioid AIM bundle will target staff, intent is to improve hospital and clinical care
  • AIM anticipates opioid bundle will be ready in July, systems are being prepared for use and AIM has created a webinar on screening, starting with hospital pilot that will assist in full rollout
  • Murr – How do treatments differ between only opioid use and opioid use disorder? Are there additional steps to identify the disorder?
    • There does not need to be a formal diagnosis necessarily, part of AIM will be helping hospital systems recognize and screen mothers

 

Tim Keesling, Texas Veterans Commission

  • Link to written testimony
  • Veterans Administration found high levels of co-occurrence with PTSD, found high levels of homelessness
  • VA has released data on opioid prescriptions and new practices related to opioid prescription, VA is looking into alternative to opioid use
  • TVC is working to intervene in at-risk populations within the veteran community, also helping mental health providers learn how to engage with veterans and their families
  • Sheffield – Have you seen any data regarding substance abuse before service? Wondering how much is due to military service
    • Do not have access to DOD data to answer
    • Many veterans discharged due to substance abuse disorders were likely not discharged honorably & will thus not receive proper care for a variety of reasons

 

Brooke Boston, Texas Department of Housing and Community Affairs

  • Highlights TDHCA programs
    • ESG competitive HUD grant program – Assists individuals find housing
    • 811 Program – Rental assistance for extremely low-income individuals with disabilities linked to long-term care, provides rental assistance when renting designated units; Targets those exiting services, those with mental health disorders, and those aging out of foster care
    • Homeless Housing and Services Program – Provides assistance to 8 largest cities, can be used for housing, provision of direct services, etc.
    • Block Grants – Can possibly be used for substance abuse initiatives
  • Price – In essence & what I wanted to highlight, TDHCA doesn’t have programs specifically dedicated to those with a substance abuse disorder, however, these individuals may benefit
    • Correct

 

Kenny Wilson, Haven for Hope

  • Gives overview of the Haven for Hope operation, treatment/recovery center in San Antonio focused on assisting homeless individuals
  • Focusing on substance abuse, Haven provides detox services, sober units, assessments of needs, etc.
  • Haven has temporary housing on the campus, works to find individuals long-term housing
  • Partners with Centers for Health Care Services to provide addiction treatment plans
  • Peer support services have been very helpful for resident recovery
  • Price – Asks after opinion on challenges faced by the state
    • Not enough housing and people need to be taught how to maintain a house, wrap-around services are vital
  • Price – How prevalent is substance abuse in the homeless population?
    • Don’t know that we have data, but it is prevalent
    • Leading substance is alcohol

 

Kevin Lenghiney, Haven for Hope

  • Peer support specialist for Haven, shares his experience
  • Moody – Asks for opinion on successful wrap-around services
    • Case management and counseling at Haven were very helpful
  • Moody – What was the largest challenge you faced in recovery?
    • Death of clients and friends
    • Wilson, Haven – Many other factors are challenging, lack of basic access to dental and other health care is huge
  • Murr discusses the staff of Haven with Kenny Wilson
  • Minjarez – Asks for specific recommendations or services needed?
    • There is a large need for recovery coaches and peer support in the judicial system

 

Ikenna Mogbo, Dallas Metrocare Services

  • Dallas Metrocare is the SB 55 (84R) expansion grant organization for veterans services, administer a number of grants through this program
  • New grant operating in 38 counties helps offset costs associated with treatment to address substance abuse needs
  • Price – What type of outreach are you doing in the 38 counties to help them access these services?
    • Partnered to help educate counties, providers are coordinated through network and Dallas Metrocare
    • Database allows for quick matching of info
    • SB 55 also allows for navigators to be sent to areas to educate and build relationships

 

Ivonne Tapia, Aliviane

  • Link to written testimony
  • Aliviane is a holistic services organizations providing a wide variety of client advocacy and support services
  • Methamphetamine abuse is rising drastically in West Texas, appearing in communities with no known presence before
  • Area also sees a large block to access to services, many are uninsured in El Paso & lack of public transport complicates the problem
  • Aliviane had to close a men’s residential center due to insufficient rates
  • Detox beds are drastically underfunded in the area
  • Prevention and intervention services are cost-effective and life-saving
  • Moody – Have met with individuals and has heard that law enforcement has been a consistent barrier, stigmatization in law enforcement interactions is high; How do we address this?
    • Education is important, community needs to know about recovery programs
  • Murr – Can you speak to rise of methamphetamine?
    • It’s cheap and available, very prevalent in Juarez

 

Posted Charge 3: Review policies and guidelines used by state agencies to monitor for and prevent abuse of prescription drugs in state-funded or state-administered programs. Include in this review policies implemented by the Texas Medicaid Program, the Division of Workers’ Compensation of the Texas Department of Insurance, the Teacher Retirement System, and the Employee Retirement System. Make recommendations regarding best practices.

Stephanie Muth, Health and Human Services Commission

  • Link to presentation
  • In addition to the PMP side, legislation added substance abuse disorder as a Medicaid treatment & this does include MAT
  • Gives overview of Drug Utilization Review Program; prospective clinical prior authorizations (PA) and review, retrospective drug utilization reviews, and utilization management tools are all tools use by HHSC to control drug usage
  • HHSC has seen a decrease in inappropriate utilization habits in the Medicaid program, new initiatives are expected to help mitigate
  • Opioids have received PA attention recently, have implemented Pas for use of strong opioids, prescribing when patient has history of prescriptions, etc.
  • Retrospective reviews can help identify prescribing practices and can help inform outreach and future PA policy
  • Price – Do you have any thoughts on days of use or day’s supply limit?
    • Have been considering day’s supply, thinking of implementing a 5-day limit
    • Managed care entities have agreed a combined approach to the opioid problem is needed, this has been discussed at a meeting with managed care in April
  • Price – So for contracts with MCOs that don’t have a limitation in place, would this be built into the next contract and could you change this?
    • We could look at this as a contract requirement, but a consistent approach is currently desired amongst managed care partners and so it may not be necessary
  • Murr – Are you discussing this with rural providers as well?
    • Will be discussed
  • PDL allows HHSC to promote use of some medications over others, e.g. promotion of use of naloxone
  • Health Steps online provider portal offers courses for professionals, some address opioid abuse
  • OIG also has tools to address opioid abuse, Medicaid Lock-In Program can restrict a member to a particular pharmacy given evidence of abuse
  • OIG can also inspect any provider for fraud, waste, and abuse
  • HHSC also operates substance abuse prevention programs that are not Medicaid funded, pg 13 provides a summary of funding sources for these programs

 

Ryan Brannon, Texas Department of Insurance

  • Link to presentation
  • Provides an overview of the Worker’s Compensation program
  • System was reformed in 2005, out of work days have been decreasing and efforts have been made to combat opioid addiction
  • Office of Medical Advisor conducts audits and maintains records of system to ensure entities follow guidelines
  • Other states are adopting Texas’ Worker’s Compensation model
  • Price – Guessing this 2005 reform was HB 7, was this done to have better control over treatment guidelines and formulary?
    • TDI DWC reform was focused on getting control of costs and giving TDI more oversight and regulatory authority
    • Rulemaking for the formulary didn’t come around until 2011 for new claims

 

Chris Voegele, Texas Department of Insurance

  • Commissioner was required to adopt evidence-based treatment guidelines in 2005 in order to reduce unnecessary and unsafe medical care
  • Rules require providers to practice within the guidelines
  • Also had a mandate to adopt a closed formulary to control drug costs, at the time drug costs were 13-14% of total medical costs in Worker’s Compensation & there was evidence that not all medications were necessary
  • Includes all FDA-approved drugs for outpatient use, but excludes “N” status drugs, can appeal to have access to these excluded drugs
  • Price – Are all Schedule II drugs excluded?
    • Based on medical evidence, drugs can be denied payment retrospectively
  • Price – What about treatment drugs discussed earlier like naltrexone and naloxone?
    • These are included, some formulations are excluded

 

DC Campbell, Texas Department of Insurance

  • Texas Labor Code requires DWC to conduct studies on the operation of the Worker’s Compensation system, focuses on the efficiency of system, but formulary work also looks to the best interest of the worker
  • Had a process to accommodate legacy claims existing before the 2011 formulary, ensured continuity of care for a number of edge cases
  • Formulary work has seen a large decrease in use of “N” status drugs
  • Regarding opioid prescriptions, 77,000 in 2009, less than 9,000 in 2015
  • Some drugs that are opioids, but not on the “N” list include hydrocodone, usage also decreased for these
  • Research and evaluation group looked at opioid usage measures from the CDC and developed an internal dosage grouping system, based on Morphine Milligram Equivalent (MME) measures, new formulary saw decreased utilization across the board
  • Surveys of workers before and after reform show increased satisfaction, return-to-work rates, etc.
  • Alvarado – Has heard of efforts in Florida that have overturned overdose trend, asks for recommendations on legislative action
    • Duration is an important factor as well, data shows this measure decreasing as well

 

Diana Kongevick, Employees Retirement System of Texas

  • Link to presentation
  • Mental health and substance abuse are in the top five chronic conditions among medical spending
  • Optum Rx is the PBM for HealthSelect, opioid utilization is similar to other Optum participants
  • Most participants taking opioids are taking doses under CDC high levels
  • ERS executive leadership is focused on the opioid crisis, very aware that family members can be addicted and can affect plan participants
  • Opioids can be useful for end-of-life care
  • ERS quantity and refill numbers are within CDC guidelines, ERS is also examining data to identify problem areas (i.e. concurrent prescription for neonatal vitamins), metrics have continued to improve into 2017

Katrina Daniel, Teachers Retirement System of Texas

  • Link to presentation
  • Administers two programs, TRS-Care and ActiveCare, Aetna as administrator and CVS Caremark as PBM
  • TRS is focused on maintain usage for legitimate care needs (end-of-life, etc.), but limiting inappropriate use
  • Similar to ERS, program complies with CDC guidelines, TRS also limits daily fill and quantities based on MME limitations
  • Can receive 200 MMEs per day with PA, anything above that requires approvals with time limits for acute and chronic pain, etc., chronic pain must be re-assessed every 3 months
  • TRS looked at districts within PBMs book of business, TRS’ spend trend has been lower than average since implementation of restrictions
  • Alvarado – So there is a 7-day usage or prescription limit? Does ERS have something similar
    • Kongevick, ERS – 7-day limit as well for short-acting, exceptions for end-of-life treatment

 

Sherri Meyer, Texas A&M System

  • Link to presentation
  • Texas A&M benefits cover employees in most areas of the state
  • Opioid claimants decreased from 10 in 2016 to 7 in 2017, Medical payments decreased from $155k to $121k
  • Provides a variety of treatment services, professional and facility services in inpatient and outpatient settings
  • Inpatient coverage requires precertification
  • Total member count for 2016 was 53.6k, opioid prescriptions totaled 9.4k or 18%
  • Most long-acting opioids are for patients with cancer, but see consistent usage of 9.4k for patients without cancer
  • Also maintain a 7-day initial fill
  • Price – So opioid usage data significantly lowers in 17/18, is this due to where we are in the year?
    • Largely yes, but we expect numbers to fall given the new restrictions

 

Laura Chamber, UT System

  • Link to presentation
  • BlueCross administers the plan, Express Scripts is the PBM
  • UT System has a 7-day limit on the plan
  • Opioid prescriptions represent less than 3% of plan prescriptions, less than 1% of plan spend, consistent with Express Scripts book of business
  • Most have filled for 10 days or less, chronic prescriptions are for chronic pain or cancer
  • Patients with an opioid prescription are typically issued from 1 doctor, UT pleased with this data and has safeguards in place to ensure patients are not being double-prescribed or abusing system
  • Plan sees consistent opioid usage levels, no increase
  • UT System has alerts at point of sale, dispensing limits, PA requirements, shared data, etc. – typical safeguards in place in plans that have presented
  • UT expecting metrics to decrease when results are received back from Express Scripts
  • Maintains Benefits Value Advisors for outreach and education, wellness programs, etc.
  • Saw 78 patients for opioid addiction treatment, 67 treated with inpatient care, 650 outpatient visits
  • Ut planning to continue tight management of programs, sharing of electronic medical records is very helpful for tracking, provider community should be engaged in treatment, should have discussions about the impact of opioids and learn to identify warning signs
  • Price – Sounds like some of these discussions are ongoing already
  • Alvarado – Glad to see that all entities are communicating and that there are a lot of common practices, wish that insurance would pay for alternative care like cryo therapy, yoga, etc.
    • This goes back to education, many don’t realize there are alternatives
  • Alvarado – We sit so much too, these things can be bothersome