Health Insurer to Adopt 5 Day Limit on Opioids

By Pat Anson, Editor

The largest health insurer in the Philadelphia area, Independence Blue Cross, has announced plans to limit the prescribing of opioids in its network to just five days for acute pain.

New Jersey and several others states have implemented or are considering laws to limit the number of days opioids can be prescribed for acute, short-term pain. But Independence is one of the first insurance companies to adopt such a measure as policy. The insurer provides health coverage to more than 2.5 million people in southeast Pennsylvania, and through its affiliates to another 8.5 million people in 25 states and Washington, DC.

Independence already limits the quantity of opioids that physicians can prescribe. The company claims that policy has reduced "inappropriate" opioid use by its members by nearly 30 percent since 2014.

"Beginning in July 2017, we will further restrict prescriptions to no more than five days for initial low dose opioids. We will continue to cover longer lengths of opioid prescription use for members suffering from cancer related pain and hospice patients," the company said in a statement.

"This safeguard prevents multiple opioid prescriptions from being filled at different pharmacies and reduces the risk for addiction while addressing legitimate pain treatment. It also reduces the risk of unused medication being diverted into the hands of unintended users."

The company said it regularly promotes the Centers for Disease Control and Prevention's opioid prescribing guidelines, however those guidelines are voluntary and only intended for primary care physicians who are treating chronic pain. They do not recommend limiting opioids for acute pain.

"Most people may not require more than 5 days of an opioid for minor operations like skin biopsies or dental procedures.  However, there are many people who will require more than 7 days due to the type of operation and the person's response to pain," said Lynn Webster, MD, past president of the American Academy of Pain Medicine. "This shows how uninformed the (insurance) payers are with limiting days of treatment.

"A 5-day limit of opioids will increase the insurance company’s profits by paying for fewer pills, but there will be people who will needlessly suffer." 

Independence's parent company reported record revenue of $16.7 billion in 2016, an increase of 21 percent from the previous year. The company ended 2016 with a surplus of $2.4 billion.

Last year, 907 people died of drug overdoses in Philadelphia. Heroin and illicit fentanyl were involved in about half of the opioid overdoses. The city is currently on track to reach 1,200 fatal overdoses in 2017.

Deaths from prescription opioids like oxycodone and hydrocodone have been declining in Philadelphia since 2013, according to the city's Department of Public Health, a year before Independence started limiting access to painkillers.