Showcasing yet another downside of the nation’s for-profit system, a new report by ProPublica and the New York Times reveals that despite the U.S. opioid crisis, many insurance companies provide easy access to highly addictive opioid medications for pain relief while restricting access to less-risky but more costly alternatives.
As the nation’s opioid epidemic has grown, “drugmakers, pharmaceutical distributors, pharmacies, and doctors have come under intense scrutiny in recent years, but the role that insurers—and the pharmacy benefit managers that run their drug plans—have played in the opioid crisis has received less attention,” note the Times’ Katie Thomas and ProPublica’s Charles Ornstein.
The pair spoke with patients who have struggled to access pain relief medications through insurance providers such as Anthem and UnitedHealthcare, the nation’s largest insurer. They also analyzed Medicare prescription drug plans that covered 35.7 million Americans and found only a third of those with coverage could access “a painkilling skin patch that contains a less-risky opioid,” whereas nearly all plans covered “common opioids, and very few required any prior approval.” Further, they found that “insurers have also erected more hurdles to approving addiction treatments than for the addictive substances themselves.”
And although addiction experts have observed that as this epidemic evolves, “the problem now appears to be rooted more in the illicit trade of heroin and fentanyl,” the reporters also note a recent Centers for Disease Control and Prevention analysis showing that “risks for chronic use” increase “with each additional day” an opioid is prescribed, and of those patients who receive initial 10-day prescriptions, 20 percent will continue using the drugs after one year.
The ProPublica/Times report provoked an outpouring of personal anecdotes that often mirrored those featured in the article, and strong condemnation of insurance companies, as well as doctors and the pharmaceutical industry.
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