The newly formed Commission on Combating Drug Addiction and the Opioid Crisis is expected to release its final report on the opioid epidemic – a report that will contain suggestions for further action – in about a week. Leading up to the release of the report, there have been a number of inquiries and actions that beg the question: what is the stance of the commission?
Commission Criticizes Insurance Companies
A recent meeting might offer a clue. During a recent opioid commission meeting – the fourth since its inception – former representative Patrick Kennedy laid into insurance companies, lambasting their inattention to the pressing concern of opioid addiction. “The historic treatment of addiction and mental illness has been a separate and unequal process,” he told insurers during the meeting. “All of you as insurers and payers have treated mental health and addiction as if it was something different from the rest of medicine.”
Insurers Claim They Are Doing Their Part
Insurance companies claimed at the meeting that they had already commenced initiatives meant to address the problem. Companies such as Aetna, Cigna, Anthem, UnitedHealth Group, Kaiser Permanente, and Blue Cross Blue Shield indicated that they had gotten rid of certain barriers to addiction treatment – namely the requirement for prior authorization before seeking medication assistance. Additionally, Marilyn Tavenner, leader of America’s Health Insurance Plans (AHIP) suggested a “multi-faceted approach,” including a campaign called the Safe, Transparent Opioid Prescribing (or STOP) Initiative, a program to help insurers judge whether a healthcare provider is abiding by CDC guidelines when prescribing opioid pain relievers.
Insurers May Be Culpable
The insurance companies’ claims fly in the face of recent reports showing a very different picture. According to a Modern Healthcare report, insurers employ extraordinarily stringent criteria when determining whether an opioid addict can be admitted to an addiction treatment facility. In one case, a teenager suffering from addiction was prevented from receiving inpatient treatment at Rogers Memorial Hospital. Without the insurance, the young kid would have had to pay over $30,000 for 30 days of treatment – an impossible payment for most people. As a result, the clinically depressed patient was forced to go back to an outpatient facility that had already failed to produce results. The insurer’s stated reason was that the inpatient treatment was not a “medical necessity.”
The Profit Motive
Insurance companies seem to be attracted to opioids due to their low costs, according to a recent report by the New York Times. In that report, NYT analysts poured over insurance plans belonging to over 35.7 million people. They found that only a third of the plans covered alternatives to opioid pain relievers.
Buprenorphine, for instance, is far less addictive than its opioid counterpart, but is very often left out of drug plans. And companies that offer lidocaine patches generally require approval from the insurance company, according to the report.
These medications are effective alternatives, but there’s one catch: they’re more expensive than opioids. That’s why every single plan studied by NYT researchers covered opioid pain relievers.
It is, therefore, encouraging that the commission is attacking the practices of insurance companies. However, it is less encouraging that Chris Christie, the chairman of the commission, recently held a meeting meant to advocate a “public-private partnership” in addressing the opioid crisis. Members of the commission were present and so were 17 CEOs from some of the top pharmaceutical firms, some of which helped fund Christie’s gubernatorial and presidential campaigns.
Christie thinks his relationship to the industry is a strength, one that he wants to capitalize on. But Dr. Adriane Fugh-Berman, professor at Georgetown University and director of PharmedOut, disagrees: “We should not be looking to industry to solve a problem they created. The answer to a pill problem is not always new pills.”
We will have to wait and see what the Commission’s report suggests, but Christie’s willingness to work with Purdue Pharma (among others) is worrisome, to say the least.