With the recent focus on the opioid crisis, employers are reviewing and adjusting benefit plan designs to do their part to reduce opioid usage. While undertaking opioid utilization reviews, ask your pharmacy vendor to provide data on benzodiazepine usage too. Benzodiazepines – Xanax, Valium, and others – are prescribed to treat anxiety, insomnia, seizures, depression, and other conditions. What you find, might be surprising.
Between 1996 and 2013 there was a 67% increase in adults filling benzodiazepine prescriptions and the overdose rate increased 400% before plateauing after 2010. A Grand Rounds analysis found that prescribing patterns vary with primary care physicians ranked in the lowest decile on quality prescribing benzodiazepines three times more than physicians ranked in the top decile. Among psychiatrists, lower quality providers prescribed benzodiazepines two times more than top quality providers. This analysis suggests that usage may be a function of the doctor the member sees, rather than evidence based prescribing.
While you’re looking at the data, analyze how many plan members are using benzodiazepines in conjunction with opioids. Mercer’s Mary Kay O’Neil, MD, says, “benzodiazepines are particularly dangerous when used in conjunction with opioids. The combination is affiliated with over 30% overdose deaths.”
Armed with this data, you’ll be able to work with your benefits advisors to adjust plan designs to reduce overuse, misuse and addiction to these drugs. And of course the Grounds Rounds analysis begs the question, what can you be doing outside your Rx program to steer members to the high-quality providers who are less likely to prescribe these drugs in the first place?