Anthem Inc. Sets Aggressive Goals to Help Prevent Addiction, Increase Access to Care

Affiliated health plans aim to double number of members getting

INDIANAPOLIS–(BUSINESS WIRE)–#addiction–More people in the United States are suffering from opioid addiction and
dying from overdose than ever before. Anthem, Inc. has been identifying
ways to help consumers better access treatment while also putting into
place policy changes that help reduce opportunities for addiction.

To help ensure consumers have access to comprehensive evidence-based
care, Anthem is committed to helping its affiliated health plans double
the number of consumers who receive behavioral health services as part
of medication-assisted therapy for opioid addiction. To address the
continued overuse of opioid prescriptions, Anthem affiliated health
plans aim to reduce the amount of opioids dispensed among their members
by 30 percent from historic peak levels by the end of 2019.

“Untreated opioid use disorders put consumers at increased risk for
experiencing a number of medical issues, including overdose, infectious
diseases associated with intravenous drug use, and death,” said Anthem
Chief Clinical Officer Dr. Craig Samitt. “Making improvements with
coordination and integration of medical and behavioral health care is an
important factor to consider in efforts to mitigate these medical risks.
Health insurers can and should play a strong role in making changes to
improve the lives of their members.”

For the last year, a large group of Anthem medical directors, nurses,
pharmacists, care managers and benefits experts have been working
closely together to re-examine policies and determine how Anthem
affiliated health plans can do their part to help prevent addiction and
provide greater access to care.

Anthem’s internal research of member claims with medical and pharmacy
benefits demonstrated that its health plans’ members aren’t getting the
best practice combination of behavioral health and drug therapy to
combat addiction. Of those who received buprenorphine products, only
about 16 to 19 percent of the members taking MAT medications for opioid
use disorder also were getting the recommended in-person counseling.

To address these findings, last year three Anthem affiliated health
plans in the northeast began rolling out standardized MAT therapy coding
for both psychiatrists and non-psychiatrist MDs certified to support MAT
treatment to maximize their reimbursement and make reimbursement
consistent for subsequent visits. In addition, Anthem is working to
connect non-psychiatrist MDs to behavioral health support to help ensure
members get counseling while receiving their drug therapy. These efforts
will be extended to all Anthem affiliated health plan states by early

To further increase access to care, Anthem affiliated health plans
recently removed their prior authorization that was intended to help
ensure clinically appropriate use including that the member was enrolled
in comprehensive counseling services for those receiving oral
buprenorphine. In addition, all of Anthem’s individual and employer, and
government-sponsored health plans have been implementing quantity limits
on short and long-acting opioids to help prevent addiction.

“It’s incumbent on us to evaluate our programs and policies on a
continuous basis and determine whether they are positively impacting our
members,” said Sherry Dubester, Anthem vice president of behavioral
health and clinical programs. “We are committed to making changes and
discovering other ways to better solve for these health care issues.”

“Population-wide addiction is not something that is resolved within a
year or two,” said Samitt. “We will continue our efforts and collaborate
with others to create an environment that provides access to appropriate
treatment and reduces addiction.”

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 nearly
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


Anthem, Inc.
Lori Mclaughlin, 317.488.6898