Aetna contacts 931 physicians prescribing the most opioids

Aetna analyzed 8.6 million insurance claims to identify and notify physicians prescribing the highest amount of opioids, The Washington Post reported.

Last week, the Hartford, Conn.-based insurer sent 931 physicians a notification reading, "You have been identified as falling within the top 1 percent of opioid prescribers within your specialty." Oncologists and other physicians who prescribe high levels of painkillers as a part of their specialty practice were excluded from the list and only physicians who prescribed opioids at least 12 times per year were included in the analysis. 

Aetna spokesperson Matthew Clyburn told Becker's Hospital Review it excluded some physicians to "avoid outliers. For example, a physician that wrote only one opioid prescription that year and refilled it once would have a 1.0 refill ratio, which is much higher than the average but not the behavior the insurer is trying to identify. By including physicians with more than 12 prescriptions in that year and looking at the refill-to-fill ratio, Aetna narrowed in on the prescribing behavior it knows leads to abuse and addiction."

Aetna CMO Harold Paz, MD, said if the 931 physicians aligned their average opioid refill rate — 4.5 per prescription — with the overall average — 0.3 per prescription — the amount of pills dispensed annually would decrease by 1.4 million.

According to Aetna data, the top prescribers of opioids were family medicine physicians (58 percent) and internists (31 percent). By state, Pennsylvania housed the most "superprescribers" at 136, while Missouri followed with 87 and Florida with 78.

Dr. Paz said showing physicians statistics is the best way to influence behavior. While Aetna said it cannot and should not evaluate physicians' judgment with each patient, it is asking physicians to check themselves.

"We're asking you to look at your practice ... and identify if the way you're prescribing narcotics is best practice," Dr. Paz told The Washington Post. "And if it's not, here's an opportunity to improve."

More articles about payer issues:
How Aetna, Cigna, Humana and Anthem fared in Q2
Humana posts large profits despite 24% decline in commercial members
UnitedHealthcare pays out $148M in quality bonuses to 1.9k physicians

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