Health Insurers' Policies Still Fueling Opioid Addiction Crisis

We have been dealing with the opioid crisis for many years now but it seems that there is very little effort by governments around the country to actually stop the addiction epidemic that feeds the profits of the pharmaceutical companies, drug wholesalers, health insurers, pharmacies, and doctors.

Despite the recommendations of his own commission, Trump has still not declared the opioid crisis a national emergency which would at least provide state and local governments with more funds to deal with the problem. A few weeks ago, I wrote about the five California counties where opioid prescriptions still outnumbered residents, a situation that has led to addiction epidemics in West Virginia most noticeably as well as Ohio, Oklahoma, and elsewhere.

Today, the NY Times reports that health insurers and the pharmacy benefit managers that run their prescription plans have been incentivizing doctors to use cheaper, more addictive pain medication rather than less or non-addictive alternatives that cost more. Even worse, the few insurers and managers that did provide some of those alternatives made them difficult to actually get by requiring prior approval. And, once someone does get addicted, the insurers make it even more difficult to actually get treatment.

As an example, United Healthcare places addictive morphine in a lower cost tier and requires no prior approval for its use while the less addictive buprenorphine is excluded from coverage entirely. Similarly, Lyrica, a non-opioid pain medication, is in the highest cost tier and patients are required to try other lower cost alternatives first.

An expert from Northwestern went so far as to say that the insurers incentivizing doctors to use these lower cost addictive pain medications is "one of the major causes of the [opioid]crisis". The former head of the Centers For Disease Control and Prevention was slightly more diplomatic, saying the insurers "not done what they need to do to address" the epidemic.

I can speak to this issue from personal experience. A family member experiencing back pain was issued a prescription for a specific pain patch. After waiting for a number of days for prior approval, she was finally able to pick up the prescription only to find out it came with an over $500 copay. She went back to taking the pain pills as infrequently as possible as they are far more affordable.

The insurers claim that the number of opioid prescriptions has actually dropped considerably over the last year or so. That is probably true as the awareness of the epidemic becomes more clear. But that probably also means that people are suffering from even more pain without sufficient means to control it. And, while it is true that fentanyl, imported from China, is becoming a leading cause of death in opioid overdoses, it is probably also true that many of those victims were addicted long before fentanyl appeared at all. And much of that addiction was driven by profits throughout the healthcare delivery system in this country.