Are Insurers Fueling Opioid Crisis?

From Health Plan Weekly

Are private and public health insurers perhaps "unwittingly" fueling the opioid crisis that claims more than 42,000 lives annually and addicts 2.1 million individuals in the U.S.? That's the provocative conclusion of a new study by researchers at Johns Hopkins Bloomberg School of Public Health.

"Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn't have well-developed policies in place to limit their overuse," says the study's senior author, G. Caleb Alexander, M.D., associate professor in the Bloomberg School's Dept. of Epidemiology.

The federally funded study evaluated 2017 coverage policies of 15 Medicare Advantage, 15 Medicaid and 20 commercial plans on 62 pharmacologic treatments for low back pain. It found that step therapy was rarely required for opioids, while prior authorization was applied to "only a minority" of covered opioids. Moreover, both public and commercial plans "tended to make covered opioids available relatively cheaply to patients."

Yet PBM executive Mesfin Tegenu, R.Ph., president of PerformRx, LLC, dismisses the study as "weak" and asserts some of the non-opioid drugs it considers are problematic.

He also views the findings as ironic. He says it is "very interesting that the prevailing sentiment for years was that health insurance in general and PBMs in particular were nothing but 'bean counters' that make money by denying services and creating roadblocks. It was very common to hear that...plans had no business getting between the [doctor-patient] relationship...Now, when it is obvious that prescribers went a bit too far and did not consider the implications of prescribing so many potentially abused medications, it is the fault of managed care for not preventing it."

Tegenu does see a widespread problem with overprescribing opioids in the U.S., though he says the responsibility is on all health care stakeholders to provide safe and effective treatments while trying to minimize negative outcomes.
 

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