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Pharmacy Benefit Management Institute Recognizes Anthem for Medicare Opioid Case Management Strategies

Press Release March 7, 2017

INDIANAPOLIS --(BUSINESS WIRE)--Mar. 7, 2017-- The Pharmacy Benefit Management Institute awarded Anthem, Inc. with its Excellence Award for Care Management Strategies. The award was granted for Anthem’s Opioid Overutilization Management Program, operated by its affiliated Medicare plans. The program reduced the number of at-risk members filing claims for opioids by 50 percent.

“More people are addicted to opioids and dying from overdose than ever before,” said Jane Lutz , executive director of PBMI. “We are pleased to recognize Anthem’s Medicare programs which are working to make a difference in this epidemic. Not only have they created a robust program, but they are tracking its progress and making appropriate adjustments to improve results in population health.”

The Opioid Overutilization Management Program was originally developed to meet criteria from the Centers for Medicare and Medicaid Services . The program identifies Medicare members, as well as dual members of Medicare and Medicaid programs, with potential opioid overuse. Case managers contact their prescribers to build their awareness and work with them to determine the best course of action. When appropriate, the program also refers beneficiaries with Anthem medical benefits to a case management program to help them begin addiction treatment.

Anthem’s programs review the last year of opioid use and then exclude members with diagnoses of cancer, as well as members receiving hospice care. Members’ prescribers are notified when members exceed program criteria on number of prescribers, pharmacies and morphine equivalent daily dose.

“Often, prescribers won’t realize that the member is filling more prescriptions for opioids written by other prescribers,” said Devanshi Sheri, clinical pharmacist who leads the program for Anthem’s Government Business Division. “Our program allows prescribers time to work with the members by looking at all their prescriptions and diagnoses holistically to assess their need for opioids. Our case managers work in tandem with the prescribers to either keep a close watch on the member to allow time for a resolution or reduce benefit coverage at the pharmacy to prevent unsafe use.”

Anthem has been identifying ways to help consumers obtain better access to treatment while also putting into place policy changes that help reduce opportunities for addiction. Anthem is committed to helping its affiliated health plans double the number of consumers who receive Medicare behavioral health services as part treatment for opioid addiction. Between a 2012 peak and 2019, Anthem affiliated health plans aim to reduce the amount of opioids dispensed to their members by 30 percent.

About Anthem, Inc.

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 73 million people served by its affiliated companies, including approximately 40 million within its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit

About The Pharmacy Benefit Management Institute (PBMI)

The Pharmacy Benefit Management Institute is dedicated to unraveling the complexities of pharmacy benefit management by providing research, continuing education, and Web resources that help organizations work effectively with their pharmacy benefit managers to improve the overall management of drug benefit programs. Learn more at

Source: Anthem, Inc.

Anthem, Inc.
Lori McLaughlin