Forum Session

Controlling Opioid Drug Excess: Health Plan Interventions
June 20, 2014


Lisa Sprague, MBA


Prescription drugs, including opioids prescribed to control severe pain, provide comfort and therapeutic benefit to millions of Americans. However, as the rate at which opioids are prescribed continues to climb, so does the incidence of misuse and abuse and the rates of overdose, emergency department utilization, and costs associated therewith. Drug overdose is currently the leading cause of injury death in the United States. Stakeholders involved in supplying, monitoring, or paying for painkillers perceive drug misuse as an epidemic menacing the country. Some promising strategies have emerged for stemming the tide, but these vary in their application depending on the state, the type of insurance plan, and patient characteristics. This Forum session looked at the perspective of health plans paying for prescription drugs in multiple states and across multiple patient populations. It explored successful initiatives, examined ongoing challenges, and considered what policy changes might lead to further progress.


Thomas Kowalski, RPh (bio)
Clinical Pharmacy Director, Health and Medical Management
Blue Cross Blue Shield of Massachusetts

Cynthia Griffin, PharmD (bio)
Senior Director, Pharmacy Government Programs
Florida Blue

Kim Caldwell, RPh (bio)
Director of Pharmacy Professional Affairs
Humana Pharmacy Solutions

Deborah Kilstein, JD, MBA (bio)
Vice President, Quality Management and Operational Support
Association for Community Affiliated Plans

Related Materials

Office of the National Coordinator for Health Information Technology, "FDAISA Health IT Report," April 2014. 

Centers for Disease Control & Prevention, National Center for Health Statistics, "Health, United States, 2013." See "Special Feature on Prescription Drugs."

Trust for America’s Health, "Prescription Drug Abuse: Strategies to Stop the Epidemic," 2013.

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