News Room

Have Health Insurers Worsened the Opioid Epidemic?

Written on behalf of Brian S. Kabateck
October 13, 2017

The statistics are sobering: the number of opioid overdoses have soared to the point where the life expectancy in the U.S. has dropped behind other leading industrialized nations. More than 52,000 people died from opioid-related deaths in 2015, which jumped up by more than 17,000 people since 2000, according to the Centers for Disease control. The CDC says 90 people die every day from prescription opioids and illicit drugs like heroin. Investigative stories written in collaboration between The New York Times and ProPublica suggest that the insurance industry shares some of the blame for a huge increase in the number of Americans addicted to painkillers.

It appears that insurance companies are limiting access to safer, less addictive pain medication because it’s cheaper to cover opioids. Reporters examined Medicare prescription drug plans covering nearly 36 million people and found that only one-third of the people covered had access to a skin patch called Butrans that contains a less-addictive opioid called buprenorphine.

Another example of insurers creating barriers to obtaining safer medication the reporters found was that every drug plan required patients to get prior approval before covering lidocaine patches, which are not addictive. The country’s largest health insurer, UnitedHealthcare, lists morphine as one of its cheapest drugs with no prior permission needed, but refused to cover the cost of Butrans, which experts say carries a lower risk of overdose.

Nearly every insurance plan pays for common opioids and rarely requires prior approval before covering the cost. It’s also easier to get addictive drugs than it is to get access to drug rehab treatment. While doctors are blamed for overprescribing opioids, they are also incentivized to offer less expensive treatments that offer fast and powerful relief.

These revelations have caught the eye of government agencies, including the Department of Health and Human Services, which is now studying whether insurance companies have made a concerted effort to make opioids more accessible than other pain management options.

Attorneys General in 37 states, including California, are now re-examining coverage policies and have reached out to the health insurance industry’s leading trade group urging its members to revise their coverage policies that may be intensifying the devastating opioid crisis.

Insurance giant Cigna is taking a step in the right direction to reduce the use of opioids by refusing the cover the cost of most Oxycontin prescriptions beginning in January 2018. The longer-lasting medication contains a higher dosage of the active ingredient which is released over an extended period of time. But if it’s crushed, melted or chewed the drug’s powerful effects are intensified, making them more attractive for abuse. Cigna says its goal is to reduce opioid use by 25% in the next three years.
Instead of covering OxyContin, Cygna is “asking opioid manufacturers to align with efforts to reduce opioid use and has signed a value-based contract with Collegium Pharmaceutical for the drug Xtampza ER, an oxycodone equivalent with abuse-deterrent properties,” a company spokesman said in a statement issued to the media.

Targeting prescription drugs alone won’t end the opioid epidemic, but if the insurance industry is willing to acknowledge it plays an important role in stemming the rising number of overdoses, there is hope that more deaths can be prevented.

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