Insurers are limiting access to less addictive pain medications as they tend to be more expensive than opioids, according to an investigative report conducted by The New York Times and ProPublica.
Here are five things to know.
1. Journalists analyzed the Medicare prescription drug plans for 35.7 million people from the second quarter of this year. Just one-third of covered individuals had access to Butrans, a painkilling skin patch that contains the less addictive opioid buprenorphine. Additionally, all plans that covered non-addictive, painkilling lidocaine patches required patients to get prior approval for the drug. Conversely, every plan covered commonly prescribed opioids, most without requirements for prior approval.
2. The report details the story of a patient named Alisa Erkes who, for two years, used Butrans to treat her abdominal pain. In January, her insurer UnitedHealthcare stopped covering the drug, which cost the company $342 for a four-week supply. Ms. Erkes switched to long-acting Morphine, which costs $29 for a month's supply.
3. In a statement, UnitedHealthcare said Ms. Erkes had not exhausted her appeals and that the company would work with her physician to find the best option for treatment.
Matthew Wiggin, a spokesperson with the insurer, told the Times, "All opioids are addictive, which is why we work with care providers and members to promote non-opioid treatment options for people suffering from chronic pain."
4. While drugmakers, drug wholesalers and physicians have come under intense scrutiny in recent years regarding their respective roles in the opioid crisis, insurers and pharmacy benefit managers have garnered less critical attention. However, there are signs to suggest this could change soon. Last week the New York State attorney general's office sent letters to CVS Caremark, Express Scripts and Optum Rx inquiring as to how the PBMs were addressing the opioid crisis.
5. Tom Frieden, MD, the head of the CDC under former President Barack Obama, said insurers with minimal exceptions had "not done what they need to do to address" America's opioid overdose crisis, according to the Times. Dr. Frieden said it's easier for patients to get opioids than it is for them to get addiction treatment.
To read the full report, click here.
More articles on opioids:
Netflix's Heroin(e) documentary shines light on women fighting West Virginia's opioid epidemic
IHI to develop intervention tool for safer opioid prescribing
Tacoma, Wash., files suit against 3 drugmakers for alleged role in opioid epidemic