Aetna Helps Members Fight Prescription Drug Abuse

An integrated approach helps prevent misuse, improve addiction treatment, and reduce medical costs

HARTFORD, Conn. – Abuse of prescription painkillers, known as opioids, is a widespread and growing problem in the United States. The epidemic adds billions of dollars to health care, work place and criminal justice costs each year. Aetna (NYSE: AET) is helping to reverse this rising trend with integrated pharmacy, behavioral health and medical programs. The programs connect health care providers and give members seamless access to the right support – mind and body – to fight addiction, while saving millions of dollars in health care.

"Every case of prescription drug abuse and every member differs. Aetna's clinical experts and data systems work to address the multiple ways abuse can start and continue. Our programs have proven to help members prevent physical and emotional harm and slow the unfortunate costs that come with opioid abuse," said Ed Pezalla, M.D., national medical director for pharmacy policy and strategy.

Innovative Prevention and Treatment Programs

Aetna's pharmacists, nurses, psychologists, psychiatrists and pain specialists work together across pharmacy and medical benefit plans to help safeguard access to opioids, identify members at risk, and provide the appropriate levels of support to fight opioid addiction.

  • Aetna's Pharmacy Misuse, Waste and Abuse program monitors access to opioids through precertification and reviews pharmacy and medical claims and quantity limits to find patterns of above-normal use. Further, members who have had frequent emergency room visits are identified. Other signs and suspicion of developing substance abuse problems or a history of controlled substance abuse also are noted. The program reduced opioid prescriptions among 4.3 million membersHMO fully insured commercial business excluding Suboxone®, Subutex and buprenorphine by 14 percent between January 2010 and January 2012.
  • Aetna nurses and psychologists in Behavioral Health‘s Medication Assistance Program work with physicians to evaluate members who could be at risk for addiction. Additionally, members with a history of opioid abuse or who are in treatment are identified and receive behavioral health support services through the Aetna Pharmacy Suboxone Case Review program. The Aetna team helps develop and track treatment plans for opioid dependence. Among participants, the program has shown a 30 percent improvement in opioid abstinence rates; a 35 percent reduction of in-patient hospital admissions and a 40 percent decrease in total paid medical costs. The program recently earned recognition by URAC as a 2013 best practice in consumer engagement and protection.

Members are eligible for the programs based on their enrollment in self-insured or fully-insured Aetna medical, pharmacy and/or behavioral health benefits.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers’ compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see


Tammy Arnold