Drug companies and doctors are being questioned about medical pain relievers.
At a time when the nation is in the grip of an opioid epidemic, many insurers are limiting access to pain medications that carry a lower risk of addiction or dependence, even as they provide comparatively easy access to generic opioid medications. Experts say that opioid drugs are generally cheaper and safer alternatives are often costlier.
Over the past few years, drug makers, pharmaceutical distributors, doctors, and pharmacies have been kept under scrutiny. Now, many question whether insurers have played a role, too. ProPublica and The New York 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. 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 for them.
UnitedHealthcare, the nation’s largest health insurer, places morphine on its lowest-cost drug coverage tier with no prior permission required, while in many cases excluding Butrans. And it places Lyrica, a non-opioid, brand-name drug that treats nerve pain, on its most expensive tier, requiring patients to try other drugs first. Many patients are scared of becoming addicted to these drugs, often requiring friends and family members to keep a close eye on their reliance of drugs. Some patients even go without the drug, despite their pain.
However, a spokesman for UnitedHealthcare said that the company was actively attempting to reduce long-term use of opioids. “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,” he said.
Insurers say they have been addressing the issue on many fronts, including monitoring patients’ opioid prescriptions, as well as doctors’ prescribing patterns.
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