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Tuesday, March 26, 2019

Reprinted with permission from ProPublica.


A prominent Democratic lawmaker asked major health insurers today whether their policies and preferred prescription drug lists have made the nation’s opioid epidemic worse.

Rep. Elijah Cummings, D-Md., the ranking member of the House Committee on Oversight and Government Reform, wrote to the companies after an article by ProPublica and The New York Times found that insurance companies sometimes favor cheaper, more addictive opioids over less addictive, but more expensive, alternatives.

“This is not a hypothetical problem,” Cummings wrote. “In my home state of Maryland, 550 people died of an overdose in the first three months of 2017 alone. Synthetic opioids like fentanyl are driving up the epidemic’s death toll, but prescription opioids contribute significantly to this crisis by fostering addiction and causing fatal overdoses.”

Cummings wrote that the industry has created financial incentives that may “steer beneficiaries to the very drugs that are fueling the opioid crisis.”

Cummings sent his letter to UnitedHealth Group, its subsidiary OptumHumanaCVS HealthAetnaAnthem, and Express Scripts, asking each company to respond to a host of questions. Express Scripts, CVS Health and Optum are pharmacy benefit managers, meaning they are hired by insurance companies and large employers to manage prescription drug benefits, set coverage rules and process medication claims.

For its part, the insurance industry trade group, America’s Health Insurance Plans, said today that it is launching an initiative to track how well doctors are following the government’s guidelines for prescribing opioids for chronic pain. Individual companies have tracked their own data but this is the first industry-wide effort to use standard measures to assess progress. The data will be shared with health plans, but at least initially will not be made public.

For our story last month, ProPublica and the Times analyzed Medicare prescription drug plans covering 35.7 million people in the second quarter of this year. Only one-third of the people covered, for example, had any access to Butrans, a painkilling skin patch that contains a less-risky opioid, buprenorphine. And every drug plan that covered lidocaine patches, which are not addictive but cost more than other generic pain drugs, required that patients get prior approval from the insurer for them.

Moreover, we found that many plans make it easier to get opioids than medications to treat addiction, such as Suboxone. Drug plans covering 33.6 million people include Suboxone, but two-thirds require prior authorization. And even if they do approve coverage, some insurance companies have set a high out-of-pocket cost for Suboxone, rendering it unaffordable for many addicts, a number of pharmacists and doctors said.

A subsequent research report published in the Annals of Internal Medicine also found that some Medicare prescription drug plans allowed relatively easy access to opioids, even at high doses. Yale University researchers compared Medicare plans from 2006 to 2015. They found that more than two-thirds of opioids — at various dosage strengths — had no restrictions in 2006 and 2011 and about one-third had no restrictions in 2015, even as the epidemic was worsening.

Restrictions usually include limits on the quantity of drugs that can be filled or requirements for prior authorization. Unrestricted access “persisted for many opioids, especially at high doses, including for drugs commonly associated with overdose,” the report said.

Cummings is the latest to ask questions following our story. Attorneys general for 37 states sent a letter to the insurance industry’s trade group, urging its members to reconsider coverage its policies. And days later, Sen. Joe Manchin, D-W.Va., sent letters asking UnitedHealth and Anthem to remove barriers to non-opioid pain treatments.

Of the insurance companies that received Cummings’ letter, Anthem declined to comment. Express Scripts said it intends to cooperate. CVS Health noted that it rolled out a host of initiatives to stem opioid abuse last month, including limits on the number of days it will cover for first-time opioid prescriptions. CVS Health also said it does not require prior approval for medications to treat addiction for members in most employer-provided plans.

Aetna said that it, too, is taking steps to address the issue. For example, it ended its preauthorization requirements on all products containing the drug buprenorphine to treat opioid addiction. “Our goal with many of our initiatives is to prevent addiction, but if it happens, we also want to be an advocate to help with treatment,” the company said.

UnitedHealth Group and Humana did not reply before this article was published.

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4 responses to “Pressure Mounts On Insurance Companies To Consider Their Role In Opioid Epidemic”

  1. FireBaron says:

    Thank you, Big Pharma, for creating this problem and walking away raking in the big bucks as part of the “solution”.

  2. Richard Prescott says:

    1.) Personal family experience wife needs pain medicine, is managed by authorized pain center. One month’s Percocet costs about $28. Lyrica, which is needed to handle what Percocet doesn’t, costs $30 per month (half the number of pills) until the donut hits, then it’s $260 per month.
    Lyrica cost a lot more than Percocet and pushes the donut into Aug, so 5 months prescriptions are a lot. With Percocets alone she never reaches the donut!
    2.) Tazanadine costs about $6 per month. Doesn’t sound bad, until you understand that the insurance company doesn’t permit Tazanadine capsules (6 mg) vs the pills (4 mg). Why you might ask? Good question, never got an answer. There should be no functional difference.
    Insurance companies make their tiers, rate their coverages, set their donuts (when the initial annual runs out) and really don’t care about the patient.
    So one might ask why can you be affected by this, why shouldn’t insurance cover it?
    Because you have to have the insurance, and she cannot get more than Medicare & Part D until she is 65 and she doesn’t have donut coverage (at a reasonable rate) because someone forgot to inform her that there was a time limit on signing up after she got accepted for disability. So she could buy heath insurance but she cannot get assistance for it, subsidized costs for it, because she cannot sign up for ACA until she is 65. And now we are seeing that it is possible the ACA will not be around and that the GOP’s version of health care is more like death care.
    As we have found out, other countries control the drug costs but the USA does not. So I know people in Canada (eg) pay a lot less all year for Lyrica.
    We have Big Pharma, and the GOP to thank for the high costs to insurance companies which promotes the distribution of lower cost but more problematic pain killers because the insurance companies don’t want to pay for less addictive stuff.

  3. This story and countless others portrays yet again the demonic and bestial impetus of both the GOP, Insurance Industry, the Fossil Fuel Industry, Tech Giants, and Big Business to devastate the nation in favor of material gain.

    Wittingly, and unwittingly in some cases, a rampant out-of-control Capitalism has risen to such heights as to suggest that only a bleak and desolate future await; we’ve built disastrous models of business leading to a state-sponsored adulation of Greed. America has been in the grips of this spiraling amoral dangerous ideology of Individualism, making it one of THE major threats to humankind on the planet—surpassing the threat of the atomic bomb insofar as likelihood of this rabid Individualism/Materialism being allowed to unleash its pernicious influences.
    (And Nationalism and Racialism, and Donald Trump are additional accelerating agents in this potentially life-ending possibility).

    America has been in the forefront of this mad dash towards a possible extinction of humanity today as we know it, and may prompt a necessity to reset the rise of humanity from “the midmost heart of the ocean”, as predicted as a possibility should humankind as a whole fail to achieve what we’ve been mandated to accomplish—a world based on humility, reciprocity, and being of service to humankind, as stated by Baha’u’llah.

    For the time being, the thirst for wealth continues unabated. Youth and children are indoctrinated to want to focus primarily on material gain—a subtle process, and sometimes openly practiced. And most of humankind and our institutions are already too inured to the perpetual quest for self-gratification, and too hardened in attitude to the point of not even wanting to improve the imbalance of ourr animal nature in relation to our angelic nature—the latter quality having been in a process of subjugation set in motion centuries ago.

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