Founded in 1945, Chattanooga-based BlueCross BlueShield of Tennessee (BCBST) is focused on serving its 3.5 million members, not just in Tennessee but across the country.
As of 2014, BCBST played a significant role in the state economy, accounting for more than a quarter of all healthcare spending in the state. BCBST has six regional offices in Tennessee.
BCBST and the Opioid Epidemic
As the opioid crisis continues to impact communities across the state and around the country, BlueCross BlueShield of Tennessee is in the middle of implementing new efforts to combat misuse of prescription painkillers. The coverage changes include:
– A seven-day limit for short-acting opioid prescriptions issued to members who are receiving the drug for the first time.
– An enhanced prior authorization requirement for extended use of short-acting opioids. This will impact those who use more than 30 days’ worth of short-acting medication in a 90-day period.
– A lower threshold for morphine milligram equivalent dose, with authorization required for more than 120 milligrams of opioids per day.
– Removal of OxyContin from its list of covered drugs, to be replaced with drugs less likely to be abused.
– Drug combination safety alerts for clinical teams and healthcare providers, highlighting inappropriate and dangerous combinations.
– Coverage of certain types of alternative pain therapy.
BlueCross leaders developed these changes with input from a statewide panel of independent medical experts, including public health officials and practicing clinicians. BCBS of Tennessee will approve prior authorization requests for members with cancer, or those receiving palliative or end-of-life treatment. Also, these changes do no apply to Medicare Advantage and TennCare members.
BCBS of Tennessee announced it as removing OxyContin from its list of covered drugs in September 2016. The shift came as a blow to one of the drugs that ignited the nationwide opioid epidemic. In place of OxyContin, doctors are encouraged to prescribe two other painkillers: Xtampza and Morphabond. These drugs, often described as “abuse-deterrent” medication, are generally more expensive than OxyContin, but members have the same copay.
BlueCross, which covers about 70 percent of insured Tennesseans, is not the first large insurer to make the switch away from OxyContin. Cigna stopped covering OxyContin in 2017, as did Florida Blue, the largest insurer in Florida.
Verifying Coverage and Finding the Best, Most Appropriate Treatment
Researching insurance options can be difficult, especially if you or someone you know is suffering with addiction. Of course, knowledgeable advisors are available with BCBST, and they can verify your coverage to find the best treatment for you. Simply call your insurance provider and ask an informed representative about the details of your individual plan.